Thread by @VarunPhadke2

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:

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?

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.

4/
Clearly, verbal communication is key. But I’m certain that we’ve all had experiences when verbal communication of recs went poorly.

(Don’t worry, #IDTwitter, I still love talking about Operation Sea-Spray! 🌉 🛥️ 🎈 🦠)

So, how can we get better at this skill intentionally?

5/
Let’s approach this w/ the frame of that tried-and-true #MedEd question: Where is the learner? (the person receiving the recs)

Think about WHERE in 3 domains:
1⃣ Where…in time/space (aka context)
2⃣ Where…in terms of prior knowledge
3⃣ Where…regarding the consult "ask"

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Each domain influences HOW to deliver verbal recommendations.

1⃣ THEIR context shapes the CONCISENESS of your recs.

Keep it brief & to the point if the listener is:
🕟 At the end of their day/shift
📞 On the phone
🧠 Rounding, prepping for the OR, multitasking, etc.

7/
Establishing their context may seem obvious, but is often overshadowed by OUR agenda as consultants.

Sometimes this means…
🌟 Deferring the less urgent recommendations to another time or day
🌟 Saving the waxing poetic for the note
🌟 Making a plan to teach later

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2⃣ THEIR prior knowledge shapes how you FRAME the discussion & recs.

If what they know is limited:
☑️ Restate the "ask" (orient them)
☑️ PROVIDE a thought process

If what they know is rich:
✅ Clarify the "ask" (orient yourself)
✅ ADD to their thought process

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Here are some ways to establish the learner’s level of knowledge about the problem & patient.

Guiding principles:
💡 Don’t make assumptions (don’t we grumble when we hear “this patient is known to your service”?)
💡 Don’t probe the learner, probe their learning environment

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Finally, 3⃣ THEIR perspective on the consult “ask” shapes your PITCH.

If you sense that they...
🤝 Are already thinking what you recommend ➡️ be empathic & affirming
🤷 Are deferring to what you think ➡️ be directive
🤔 Will disagree with you ➡️ be curious & collaborative

11/
We'll explore this last element more fully in a future thread on navigating consult conflict.

For now, let's introduce a basic strategy for initiating & calibrating the "pitch".

I always lead w/ some version of “Tell us what your team thinks about…[the case, the dilemma]"

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This simple question helps set up the “emotional valence” of the recommendations as you deliver them.

Here’s an example from a common encounter between ID and primary teams.

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With experience, recognizing the primary team’s perspective on the consult “ask” becomes easier.

This may be based on:
*⃣ The consult "type" requested
*⃣ The "ask" itself
*⃣ The team/person making the "ask"
*⃣ The interpersonal dynamic when delivering recs

14/
This means experienced consultants adjust their communication style intuitively and on-the-fly.

But this may NOT be intuitive to learners on consult teams whose only previous perspective was that OF a primary team.

So how do we teach this?

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In this figure I've summarized strategies I've found helpful.

Big picture goals:

1⃣ Reinforce communication skills that build trust & cultivate a positive consult culture
2⃣ Develop skills in the “art of persuasion”
3⃣ Empower learners to be the team representative

16/
A recap.

In this 🧵 we learned:
🌟 Verbal recs are 🗝️ to better teaching/engagement by & w/ consultants
🌟 A “Where is the learner?” framework helps us think through HOW to give verbal recs
🌟 We can build consult communication skills intentionally w/ specific strategies

17/
Next week @JenniferSpicer4 will continue this series on “Teaching Consultant Skills,” w/ “Writing Notes.”

Remember to check out #SubspecialtyTeaching @MedEdTwagTeam to keep up with all our threads in one place!

See you next week!