Discover and read the best of Twitter Threads about #subspecialtyteaching
Most recents (13)
1/
You’re starting a consult service block.
But this time is different.
-Maybe you don’t have a consult “team” to teach
-Maybe you want to showcase your specialty & recruit interested trainees
-Maybe you want to build ties to other service lines
What to do?
This week:
You’re starting a consult service block.
But this time is different.
-Maybe you don’t have a consult “team” to teach
-Maybe you want to showcase your specialty & recruit interested trainees
-Maybe you want to build ties to other service lines
What to do?
This week:
2/
@JenniferSpicer4 and I have spent the last few weeks exploring the "why", the "who", and the "when" of teaching the primary team in our role as consultants.
Now let's turn to the "what".
What repertoire of teaching scripts should we strive to develop as specialists?
@JenniferSpicer4 and I have spent the last few weeks exploring the "why", the "who", and the "when" of teaching the primary team in our role as consultants.
Now let's turn to the "what".
What repertoire of teaching scripts should we strive to develop as specialists?
3/
1⃣ Content knowledge
It's natural to gravitate toward teaching specialty-specific content - that's our expertise!
We've covered a lot of this territory in prior threads.
I'm going to highlight some of those pearls & point out specific strategies for teaching primary teams.
1⃣ Content knowledge
It's natural to gravitate toward teaching specialty-specific content - that's our expertise!
We've covered a lot of this territory in prior threads.
I'm going to highlight some of those pearls & point out specific strategies for teaching primary teams.
1/ You're seeing a new consult with your team, and you want to teach the primary team too.
But WHEN is the best time to teach them?
On the phone?
At the bedside?
In their team room?
And in the morning?
Or maybe the afternoon?
This week:
But WHEN is the best time to teach them?
On the phone?
At the bedside?
In their team room?
And in the morning?
Or maybe the afternoon?
This week:
2/ Last week @VarunPhadke2 described all of the individuals whom we can teach during the day.
But when should we teach them?
Often we default to teaching on the phone when receiving the consult or giving recommendations, but there are other options too.
But when should we teach them?
Often we default to teaching on the phone when receiving the consult or giving recommendations, but there are other options too.
3/ This week we will discuss the pros & cons of those options.
With one caveat.
Often the best time to teach is the one most convenient to your team & the primary team, which depends on your local institution's workflow.
But let's explore some general principles to consider.
With one caveat.
Often the best time to teach is the one most convenient to your team & the primary team, which depends on your local institution's workflow.
But let's explore some general principles to consider.
1/
You staff a new consult w/ your team. You share pearls & make a plan.
Then:
🩻 You review the CT w/ radiology.
🤝 You chat w/ another consult service.
🗣️ You deliver your recs at the workroom.
📲 You call night float w/ an update.
So many opportunities to teach!
This week:
You staff a new consult w/ your team. You share pearls & make a plan.
Then:
🩻 You review the CT w/ radiology.
🤝 You chat w/ another consult service.
🗣️ You deliver your recs at the workroom.
📲 You call night float w/ an update.
So many opportunities to teach!
This week:
2/
Last week @JenniferSpicer4 kicked off our segment on "Teaching the Primary Team" by focusing on "The Why."
This week, for "The Who", I want to think beyond just the primary team to identify the many different learners we encounter as consultants.
Last week @JenniferSpicer4 kicked off our segment on "Teaching the Primary Team" by focusing on "The Why."
This week, for "The Who", I want to think beyond just the primary team to identify the many different learners we encounter as consultants.
3/
Why?
Even though the primary team is the obvious audience for teaching - their "ask" is what invited us into the case to begin with! - we usually interface with many other teams in the process of rendering our opinion.
All of these teams have learners we can impact!
Why?
Even though the primary team is the obvious audience for teaching - their "ask" is what invited us into the case to begin with! - we usually interface with many other teams in the process of rendering our opinion.
All of these teams have learners we can impact!
1/
2pm. Usual day on ID consults.
Learner: “So the patient had [complex multi-stage procedure w/ prosthetic material] yesterday. Turns out they were bacteremic.”
You: "and...?"
Learner: "They want antibiotic recs...I'm not sure how to approach that..."
You: 🤷
This week:
2pm. Usual day on ID consults.
Learner: “So the patient had [complex multi-stage procedure w/ prosthetic material] yesterday. Turns out they were bacteremic.”
You: "and...?"
Learner: "They want antibiotic recs...I'm not sure how to approach that..."
You: 🤷
This week:
2/
Consultants are often called upon for input on management.
Typically, this means helping with a clinical decision (which test? which treatment?).
Management reasoning refers to the cognitive processes by which clinicians make those decisions.
pubmed.ncbi.nlm.nih.gov/29800012/
Consultants are often called upon for input on management.
Typically, this means helping with a clinical decision (which test? which treatment?).
Management reasoning refers to the cognitive processes by which clinicians make those decisions.
pubmed.ncbi.nlm.nih.gov/29800012/
3/
Teaching & assessing clinical decision-making skills is HARD.
Without a framework for the cognitive processes involved, it can be challenging to isolate the specific skills a learner needs to work on.
This leads to unhelpful feedback like "lacks confidence" (which = 🤷).
Teaching & assessing clinical decision-making skills is HARD.
Without a framework for the cognitive processes involved, it can be challenging to isolate the specific skills a learner needs to work on.
This leads to unhelpful feedback like "lacks confidence" (which = 🤷).
1/
You’re staffing a complex patient w/ a learner on your consult team.
As they present it's clear the case was challenging for them.
They get to their assessment & take a breath.
You hit ⏸️ & say…”You know what? Let’s think through this dx together.”
What next?
This week:
You’re staffing a complex patient w/ a learner on your consult team.
As they present it's clear the case was challenging for them.
They get to their assessment & take a breath.
You hit ⏸️ & say…”You know what? Let’s think through this dx together.”
What next?
This week:
2/
Consultants are often asked to assist with diagnosis.
What do we bring to the table?
An easy answer is deeper knowledge of a specific subset of presenting problems & diseases.
Focused clinical exposure means that we develop a unique & rich library of schemas & scripts.
Consultants are often asked to assist with diagnosis.
What do we bring to the table?
An easy answer is deeper knowledge of a specific subset of presenting problems & diseases.
Focused clinical exposure means that we develop a unique & rich library of schemas & scripts.
3/
Though specialty-specific knowledge is essential to effective diagnostic reasoning for consultants, it is not enough.
Our unique 'invited' role in cases means we also need to have specific (meta)cognitive skills & habits.
Those skills/habits are part of a teachable process.
Though specialty-specific knowledge is essential to effective diagnostic reasoning for consultants, it is not enough.
Our unique 'invited' role in cases means we also need to have specific (meta)cognitive skills & habits.
Those skills/habits are part of a teachable process.
1/ A member of your consult team presents a patient w/ suspected neurosyphilis.
Your team:
⭐️ 3rd year medical student
⭐️ IM intern
⭐️ 2nd year IM resident
⭐️ 1st year ID fellow
How can you possibly provide valuable teaching to all of them?
This week: Multi-level teaching
Your team:
⭐️ 3rd year medical student
⭐️ IM intern
⭐️ 2nd year IM resident
⭐️ 1st year ID fellow
How can you possibly provide valuable teaching to all of them?
This week: Multi-level teaching
2/ Teaching multi-level learners is hard.
Their range in baseline knowledge means a single teaching point is often not effective for everyone.
So how can you support everyone's learning without taking too long and/or boring others?
Their range in baseline knowledge means a single teaching point is often not effective for everyone.
So how can you support everyone's learning without taking too long and/or boring others?
3/ A prior thread discussed the importance of clarifying learners' needs & interests at the beginning of the rotation.
This is one 🗝️ for effective multi-level teaching.
Know what materials is RELEVANT and INTERESTING for each learner level.
This is one 🗝️ for effective multi-level teaching.
Know what materials is RELEVANT and INTERESTING for each learner level.
1/
9am. Consults.
Them: “We want you on board because ____ is 'refusing' to do this procedure but ____ says it's needed. You're the tiebreaker.”
You: [sigh] “OK.”
⌛️
Patient: “Ah! ____ said YOU'RE the one holding up my discharge!”
You: 🙄
Feeling triggered yet?
This week:
9am. Consults.
Them: “We want you on board because ____ is 'refusing' to do this procedure but ____ says it's needed. You're the tiebreaker.”
You: [sigh] “OK.”
⌛️
Patient: “Ah! ____ said YOU'RE the one holding up my discharge!”
You: 🙄
Feeling triggered yet?
This week:
2/
Conflict is inevitable when working within a system.
What do I mean when I say “conflict”? 🤔 For the purposes of this 🧵 let me paraphrase a huge body of literature w/ the following definition:
Conflict is “disagreement” that causes (or has the potential to cause) “harm”.
Conflict is inevitable when working within a system.
What do I mean when I say “conflict”? 🤔 For the purposes of this 🧵 let me paraphrase a huge body of literature w/ the following definition:
Conflict is “disagreement” that causes (or has the potential to cause) “harm”.
3/
Let's unpack this a bit more w/ a focus on conflict in consultative care.
"Disagreement" is a broad term.
It can stem from...
↪️ real OR perceived differences in opinion
↪️ about diagnosis OR management
↪️ between the primary team & the consultant OR between consultants
Let's unpack this a bit more w/ a focus on conflict in consultative care.
"Disagreement" is a broad term.
It can stem from...
↪️ real OR perceived differences in opinion
↪️ about diagnosis OR management
↪️ between the primary team & the consultant OR between consultants
1/ *Re-consult 📞*
You: What did the last consult note say?
Them: I don't know how to interpret it...
*reading the ✍️ yourself*
#Sepsis
- send tick serologies
- start broad-spectrum antibiotics
- we will follow up OSH data
You: 🤦 I feel you... We'll see the patient again.
You: What did the last consult note say?
Them: I don't know how to interpret it...
*reading the ✍️ yourself*
#Sepsis
- send tick serologies
- start broad-spectrum antibiotics
- we will follow up OSH data
You: 🤦 I feel you... We'll see the patient again.
2/ You wonder...
💭 What tick serologies were we referring to?
💭 What antibiotics were we wanting to start?
💭 And which OSH has prior records?
And you're not the only one wondering...
How can we ✍️ more effective notes?
💭 What tick serologies were we referring to?
💭 What antibiotics were we wanting to start?
💭 And which OSH has prior records?
And you're not the only one wondering...
How can we ✍️ more effective notes?
1/
5pm. ID consults.
On 📞 giving recs re: culture growing Serratia.
Them: TY for seeing our patient!
You: Of course! BTW do you know the hx of Serratia? No? Well let me tell you about Operation Sea-Spray…
⌛️
Them: ...So should we start abx? Which one?
You: 😳
This week:
5pm. ID consults.
On 📞 giving recs re: culture growing Serratia.
Them: TY for seeing our patient!
You: Of course! BTW do you know the hx of Serratia? No? Well let me tell you about Operation Sea-Spray…
⌛️
Them: ...So should we start abx? Which one?
You: 😳
This week:
2/
So far @JenniferSpicer4 & I have explored consultant skills pertaining to the consult "ask".
We'll now focus on how to respond to the ask, verbally & through notes.
Let's start w/ a poll of those of you who CALL consults:
What is your PREFERRED way to receive consult recs?
So far @JenniferSpicer4 & I have explored consultant skills pertaining to the consult "ask".
We'll now focus on how to respond to the ask, verbally & through notes.
Let's start w/ a poll of those of you who CALL consults:
What is your PREFERRED way to receive consult recs?
3/
Previous studies suggest that verbal communication of consultant recs – especially initial recs - is preferred by most clinicians.
Additionally, lack of in-person interaction w/ consultants is one factor hospitalists identify as negatively impacting learning & patient care.
Previous studies suggest that verbal communication of consultant recs – especially initial recs - is preferred by most clinicians.
Additionally, lack of in-person interaction w/ consultants is one factor hospitalists identify as negatively impacting learning & patient care.
1/ *Consult team room*
A brand-new learner joins your consult team.
You share details about a new consult & schedule ⏱️ to meet in the afternoon to staff.
⌛️
5 minutes into their presentation you realize, "Oh no. I'm going to have to redo this consult, aren't I?"
A brand-new learner joins your consult team.
You share details about a new consult & schedule ⏱️ to meet in the afternoon to staff.
⌛️
5 minutes into their presentation you realize, "Oh no. I'm going to have to redo this consult, aren't I?"
2/ Learners on consult teams must tackle unfamiliar and complex questions, often with less time to evaluate a patient and develop a plan than on primary services.
3/ This @AcadMedJournal paper by @s_brond describes factors that contribute to cognitive load on consults.
pubmed.ncbi.nlm.nih.gov/34348389/
Although this article focuses on the experiences of fellows, other learners likely struggle with some of these areas as well.
pubmed.ncbi.nlm.nih.gov/34348389/
Although this article focuses on the experiences of fellows, other learners likely struggle with some of these areas as well.
1/
Fri. 4PM. You just got consult #8.
Then, a call: "We have a new consult. This patient's been here for 2 weeks. We’re not sure what’s going on & wanted you on board.”
😱
You: "…so, what’s the question…?"
How do we improve this interaction?
This week: Receiving Consults
Fri. 4PM. You just got consult #8.
Then, a call: "We have a new consult. This patient's been here for 2 weeks. We’re not sure what’s going on & wanted you on board.”
😱
You: "…so, what’s the question…?"
How do we improve this interaction?
This week: Receiving Consults
2/
About 3 yrs ago on a thread about the cognitive aspects of consults I posted this poll:
Nearly 2/3 of >1100 respondents said “anticipated pushback” was the biggest anxiety-inducing factor when calling a consult.
This is a problem.
About 3 yrs ago on a thread about the cognitive aspects of consults I posted this poll:
Nearly 2/3 of >1100 respondents said “anticipated pushback” was the biggest anxiety-inducing factor when calling a consult.
This is a problem.
3/
"Pushback" can be intentional or perceived. Either way it is not a desirable component of consultation (for EITHER side).
This week our focus is the consult request interaction, including its goals & downstream consequences, and strategies to make it more productive.
"Pushback" can be intentional or perceived. Either way it is not a desirable component of consultation (for EITHER side).
This week our focus is the consult request interaction, including its goals & downstream consequences, and strategies to make it more productive.
1/ Do you reminisce about the days when every learner on your consult team began their rotation w/ you on the SAME day?
When you had to set expectations just once?
And you NEVER, EVER had to repeat yourself?
(Yeah, right 😉)
This week: Setting Expectations on Consult Teams
When you had to set expectations just once?
And you NEVER, EVER had to repeat yourself?
(Yeah, right 😉)
This week: Setting Expectations on Consult Teams
2/ Whenever I want a refresher on setting expectations, I refer to this high-yield previous thread by @GStetsonMD
There you will find lots of pro tips about:
❓ Why we set expectations
❓ What kinds of expectations to set
❓ How to set expectations
There you will find lots of pro tips about:
❓ Why we set expectations
❓ What kinds of expectations to set
❓ How to set expectations
3/ I’m not going to rehash those concepts here.
So…what ELSE do subspecialty educators need to know about setting expectations?
Let’s think about some unique considerations (and challenges!) for teachers on consult teams...
So…what ELSE do subspecialty educators need to know about setting expectations?
Let’s think about some unique considerations (and challenges!) for teachers on consult teams...
1/ Ready for another #TweetorialTuesday from the @MedEdTwagTeam? Say no more #MedEd #MedTwitter friends!
This week we are launching our series on #SubspecialtyTeaching!
This week we are launching our series on #SubspecialtyTeaching!
2/ If you’re a clinical teacher in a subspecialty & wanted to incorporate pearls from #TweetorialTuesday, you've probably said to yourself (like I did):
WHEN? My days have ZERO predictability
WHAT? My learners are all at a VERY different place
WHO? My team seems to change QOD
WHEN? My days have ZERO predictability
WHAT? My learners are all at a VERY different place
WHO? My team seems to change QOD
3/ In this series @JenniferSpicer4 and I will share strategies for YOU, focusing on teaching as a [sub]specialist.
Our scope:
🌟 Teaching as an inpatient CONSULTANT
🌟 Teaching the CONSULT team (team hoping to provide help)
🌟 Teaching the PRIMARY team (team asking for help)
Our scope:
🌟 Teaching as an inpatient CONSULTANT
🌟 Teaching the CONSULT team (team hoping to provide help)
🌟 Teaching the PRIMARY team (team asking for help)
