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
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)
4/ Let’s start with some questions:
What is the BIGGEST challenge to teaching your OWN team in your role as a consultant?
(If the poll doesn’t capture your answer, Tweet us!)
5/ What is the BIGGEST challenge to teaching the PRIMARY team in your role as a consultant?
(If the poll doesn’t capture your answer, Tweet us!)
6/ There are multiple unique challenges to teaching as a specialty consultant.
Let’s unpack a few of these as a prelude to future threads…
(This list is NOT meant to be exhaustive. Please Tweet us the challenges you struggle with to help define content you want to see!)
7/ Challenge #1 – Time
Consult teams often have a totally different flow to their day than inpatient teams. Why?
📈 Workload (aka consults) unpredictable and often without a “cap”
⚖️ Competing patient care activities & inpatient consults (specialty clinic, procedures, etc)
8/ Challenge #2 – Wide spectrum of learners
Subspecialty teachers must modulate their expectations & teaching for many learners…
⭐️ Learners on the CONSULT team
⭐️ Learners on the PRIMARY team
⭐️ Learners on OTHER teams (other consultants!)
All w/ different schedules!
9/ Challenge #3 – Meta-cognition
Specialists usually encounter patients after some workup & management has already occurred. Effective consultation is thus intrinsically metacognitive.
Being mindful of what *others* were or are thinking influences WHAT and HOW to teach.
10/ Challenge #4 – Different role
A specialist’s involvement in a case is usually “invited” & NOT the default. This comes with implications for etiquette about how to establish your role (aka “the consult question”), decision-making, & communication.
These are LEARNED skills!
11/ Challenge #5 – Uncertainty
All clinicians deal w/ uncertainty. But specialists are often asked to adjudicate decisions b/c they have more cumulative EXPERIENCE w/ problem with no right answer.
Specialists must be mindful of how INDIVIDUAL practice influences teaching!
12/ Many of these challenges affect BOTH generalists & specialists.
We'll focus on aspects that uniquely impact teaching as a specialist in the consultant role.
What others would YOU add?
(We would especially love the perspective of our procedural colleagues!)
13/ Next week @JenniferSpicer4 will be discussing how to structure your day on consults to get work done AND teach.
-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?
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:
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.
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.
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”.
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