What Makes the Perfect Inpatient Consultation? A Qualitative Analysis of Resident and Fellow Perspectives

Pavitt, Sara; Bogetz, Alyssa L.; Blankenburg, Rebecca

doi:10.1016/j.acap.2018.04.069

Cited by 3 publications

(5 citation statements)

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“…9 Although studies have examined learning for trainees requesting consults, we found no literature describing learning for trainees performing consults. [10][11][12][13] To optimize learning during consults by modulating IL, EL, and GL, 8 researchers must first measure these components to understand the role of CL during consults. Then, educators can take steps to avoid trainee cognitive overload, thereby improving patient care and reducing errors.…”

Section: Discussionmentioning

confidence: 99%

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The Cognitive Load of Inpatient Consults: Development of the Consult Cognitive Load Instrument and Initial Validity Evidence

et al. 2021

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PurposeFellows and residents provide inpatient consultations. Though consults vary considerably, measuring the associated cognitive load (CL) is key to guiding faculty on how to optimize learning during consults. However, existing CL instruments, such as the unidimensional Paas scale, cannot separate the 3 components of CL and may miss the nuances of consult CL. Therefore, the authors developed the Consult Cognitive Load (CCL) instrument to measure the 3 CL components during consults. To provide a window into the vital yet underresearched consult learning environment and to improve training and patient care, we developed a multidimensional instrument to measure the mental effort associated with trainees completing inpatient consults.

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Section: Discussionmentioning

confidence: 99%

“…Then, educators can take steps to avoid trainee cognitive overload, thereby improving patient care and reducing errors. 12,14 However, the most wellknown CL measure, the Paas scale, 6 consists of a single item and thus functions unidimensionally. The Paas scale is, therefore, unlikely to capture the nuances of IL, EL, and GL during consults.…”

Section: Discussionmentioning

confidence: 99%

The Cognitive Load of Inpatient Consults: Development of the Consult Cognitive Load Instrument and Initial Validity Evidence

et al. 2021

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“…Be patient--it can be difficult for requesting teams to articulate a clear clinical question for a consult, especially if they are not familiar with the condition they are calling about [ 7 ]. When you ask clarifying questions, spend an extra moment to explain why you are asking those specific questions by providing a background on your thought process [ 8 ]. Apply a similar approach to requesting additional laboratory tests or imaging studies.…”

Section: Introductionmentioning

confidence: 99%

“…Consultants should search for teaching opportunities during the consult follow-up, where most education of the primary team occurs [ 7 ]. Primary teams who feel comfortable with their consultants are more likely to engage in a conversation that facilitates a deeper understanding of the consult team’s reasoning [ 8 ]. This does not need to be a lengthy process—a two to three minute conversation in the workroom on your way off the floor can do wonders for collegiality, coordination of care, and education.…”

Section: Introductionmentioning

confidence: 99%

Inpatient Dermatology Best Practice Strategies for Educating and Relaying Findings to Colleagues

2020

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Purpose of Review This review examines the role of education and relaying findings to non-dermatologist colleagues when performing inpatient dermatology consults. We highlight best practices for communication and education. Recent Findings Non-dermatologists receive minimal training on the diagnosis and the management of skin conditions. Efforts to teach dermatology in the inpatient setting via traditional didactics have been met with limited success, and hospitalists have indicated a desire to learn from specialists. Incorporating education into standard consultation practices including the note, one-on-one communication, and bedside rounds can efficiently improve teaching and patient care. Summary Our key principles of consultation emphasize communication, use of pre-existing components of a consultation to teach, and close follow-up. Inpatient dermatologists can implement these simple but effective measures to encourage education and communication with primary teams for both in-person and telehealth consults.

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“…The role of fellows as resident supervisors on inpatient subspecialty rotations is an example of a near-peer learning dynamic because fellows are “neither professional educators nor experts in a given field; they teach their peers or junior learners while they themselves continue to learn.” 3,4 Possible advantages of the near-peer learning dynamic include the increased comfort of learners in sharing areas of weakness and the ability of near-peer educators to detect learners who are having difficulty. 3 Although there has been significant focus on the fellow–resident interaction during subspecialty consultations, 5–9 a related but different near-peer learning dynamic, the same attention has not been paid to the role of fellow as resident supervisor on inpatient subspecialty rotations. Although fellows are expected to supervise residents, 2 they receive little training on how to be successful in this role, and unlike faculty 10 and senior residents, 11 for whom there is evidence to inform best supervisory practices, to our knowledge, no such data exist for fellows.…”

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confidence: 99%

Bridge Builders: A Qualitative Study of Fellows’ Successful Supervision of Residents

et al. 2022

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Purpose Clinical fellows, those training to become subspecialists in a program certified by the Accreditation Council for Graduate Medical Education, supervise residents on inpatient subspecialty rotations. Unlike for supervising residents or for faculty, there is a paucity of literature describing fellows’ supervision of residents. The aim of this study was to understand residents’ and fellows’ perception of successful supervision of residents by fellows on inpatient subspecialty rotations to inform the development of curricula to support fellows as supervisors. Method Using grounded theory methodology, the authors held focus groups in May 2020 of pediatric residents and pediatric subspecialty fellows at Boston Children’s Hospital, Boston, Massachusetts. Focus groups were conducted until thematic saturation was achieved. Deidentified transcripts were independently coded by 2 authors. The author team consolidated the codes into themes and developed an interpretive model for fellows’ successful supervision of residents. Key results were confirmed via member checking. Results The authors conducted 4 resident focus groups, composed of 16 pediatric residents, and 4 fellow focus groups, composed of 13 pediatric subspecialty fellows. Participants perceived that fellows who provided successful resident supervision advanced residents’ professional growth and supported residents’ development along 5 “bridges”: (1) generalist to subspecialist, (2) trainee to autonomous practitioner, (3) individual to member of the interprofessional team, (4) emerging physician to patient-facing care provider, and (5) newcomer to engaged clinical learner. Fellows can further residents’ growth in these areas by demonstrating approachability, empathy, appreciation, and kindness. Conclusions As newcomers on inpatient subspecialty rotations, residents engage in legitimate peripheral participation. Fellows who are successful supervisors move residents toward full participation in their profession via the bridge model. The fellow-resident dynamic carries advantages of near-peer learning. Fellows can harness their role, subspecialty knowledge, and familiarity with the training environment to enhance resident supervision.

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What Makes the Perfect Inpatient Consultation? A Qualitative Analysis of Resident and Fellow Perspectives

Cited by 3 publications

References 0 publications

The Cognitive Load of Inpatient Consults: Development of the Consult Cognitive Load Instrument and Initial Validity Evidence

The Cognitive Load of Inpatient Consults: Development of the Consult Cognitive Load Instrument and Initial Validity Evidence

Inpatient Dermatology Best Practice Strategies for Educating and Relaying Findings to Colleagues

Bridge Builders: A Qualitative Study of Fellows’ Successful Supervision of Residents

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