Thread by @JenniferSpicer4

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?"

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.

4/ So how can we help learners approach effective data gathering?

We can tell them which data are most relevant for the consult "ask"

While this is somewhat case- & specialty-specific, we CAN categorize the kinds of "asks" that specialists get to develop a structured approach.

5/ As teachers on specialty services, it's our responsibility to help learners by explicitly telling them the consult "ask"...

...and then TEACH them what information they need to gather.

6/ @VarunPhadke2 discussed last week how identifying the "consult type" is a key part of “receiving the consult”

https://twitter.com/VarunPhadke2/status/1600306987786727424

7/ Prior articles have also described frameworks for grouping consultation types.

pubmed.ncbi.nlm.nih.gov/30768469/

For the purposes of this thread, I've reorganized the framework from this article & @VarunPhadke2's thread into a new one.

8/ Each of these 5 "consult asks/types" requires different information.

Therefore, if we identify the consult type, we can provide targeted guidance to our learners about what data they should gather, thus saving them (and us) time.

9/ Whereas diagnostic dilemmas require substantial data gathering from the patient, the chart, & potentially discussions with other health professionals (e.g., radiology, pathology, etc.)...

...management dilemmas require more time reading guidelines, primary literature, etc.

10/ Here's an example of what this looks like for a common diagnostic dilemma we see in ID:

🌡️Fever of unknown origin (FUO)
#IDTwitter

Notice how the attending/fellow GUIDES the learner about WHAT info to obtain, WHERE to get it, and what NOT to spend time on.

11/ Here is an example of how this guidance may differ for a consult where the primary team is requesting a procedure - like a colonoscopy to assess for chronic diarrhea in an immunocompromised patient.

Remember, this isn't obvious to your learners, it's our job to GUIDE!

12/ Then use the time staffing consults to role model effective data gathering:

📌 What do you LOOK AT in the chart?
📌 How do you PHRASE key questions?
📌 What EXAM maneuvers are important?
📌 What QUESTIONS do you ask radiology? other consultants? the micro lab?

13/ Remember, data gathering is a skill.

It's not intuitive to learners what information is important, so help them find the signal in the noise.

This is where experience & expertise matter!

14/ So next time you're assigning a consult to a learner, streamline their workflow and help their data gathering by:

✅ Identifying the "consult type"
✅ Orienting them to what info is important
✅ Providing them with resources to help

It will save ⏱️ - for you and them!

15/ Next week @VarunPhadke2 will continue this series on "Teaching Consultant Skills" with "Verbal Communication of Recs."

Remember to check out #SubspecialtyTeaching @MedEdTwagTeam to find all our threads in one place!

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