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: 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."

https://twitter.com/JenniferSpicer4/status/1628082665025941512?s=20

This week, for "The Who", I want to think beyond just the primary team to identify the many different learners we encounter as consultants.

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: 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/

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: 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.

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: 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”.

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?

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 2/
About 3 yrs ago on a thread about the cognitive aspects of consults I posted this poll:

https://twitter.com/VarunPhadke2/status/1233841954615681025

Nearly 2/3 of >1100 respondents said “anticipated pushback” was the biggest anxiety-inducing factor when calling a consult.

This is a problem.

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 2/ Whenever I want a refresher on setting expectations, I refer to this high-yield previous thread by @GStetsonMD

https://twitter.com/GStetsonMD/status/1303329970526105600

There you will find lots of pro tips about:
❓ Why we set expectations
❓ What kinds of expectations to set
❓ How to set expectations

1/ Ready for another #TweetorialTuesday from the @MedEdTwagTeam? Say no more #MedEd #MedTwitter friends!

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

1/ “I’ve got a consult for you.”

A standard refrain for subspecialists, but one that often generates significant stress on both ends of the call.

Why?

Q: If you have ever felt anxiety about calling a consult, what was the cause of most of your stress? 2/ Consultation is an indispensable component of medical practice – the field is too vast and new science emerges too rapidly for any one specialty to stay current.

Thus, collegial and effective consultation is essential.

1/9

@rabihmgeha shared a fantastic approach to positive BCx! I use a similar schema, but add ‘Questions to ask the lab/what to do next?’ since #ID usually doesn’t get the ‘critical result’ call from micro, and I want to empower those who do with actionable knowledge. 2/

I arrange the potential Gram stain results that one can be called w/ as follows: Gram(+) cocci, Gram(+) rods, Gram(–) rods, Gram(–) cocci, yeast. Gram(+) cocci are grouped by ‘morphology’ since the lab usually tells you this: clusters, pairs, chains, etc. Fill in with orgs.

1/

Hello everyone! I’ve been inspired by #MedEd colleague @JenniferSpicer4 to make my foray into #IDTwitter. I’m jumping right in with a #Tweetorial that combines my curiosity for the language of medicine and passion for powerful visuals and teaching about antibiotics! 2/

I’ve always been intrigued by how we describe abx decisions – ‘narrow’, ‘broaden’, ‘expand’, ‘[de]escalate’, etc. For my UME micro course, I made a figure that captures this terminology and lets learners compare/contrast spectra of activity visually.

Let’s build it together.