Teaching during consultation: factors affecting the resident-fellow teaching interaction

Abstract

Residents and fellows want to engage in positive teaching interactions in the context of the clinical consult; however, multiple barriers influence both parties in the hospital environment. Many of these barriers are amenable to change. Interventions aimed at reducing barriers to teaching in the setting of consultation hold promise for improving teaching and learning on the wards.

Learning how to learn using simulation: Unpacking disguised feedback using a qualitative analysis of doctors’ telephone talk

“…In addition to explicit feedback and teaching over the phone (Miloslavsky et al 2015) that has been previously described, our results show that much of the feedback residents receive during telephone talk is implicit or 'disguised'. Thus, our findings align with recent conceptualizations of feedback as 'performance relevant information' (PRI) (van der Leeuw et al 2017).…”

Teaching & Learning Tips 10: Interspecialty teaching through inpatient dermatology consults

“…While patient care is the primary focus, inpatient consults at academic hospitals provide teaching and learning opportunities for trainees. Trainees on the primary and consult teams view interspecialty education as an integral part of the consult process but identify the following as potential barriers:…”

“…in Miloslavsky et al3 )Teach the primary team which preliminary tests can be ordered based on an initial differential and how to convey pertinent results Ownership of patient Teach the primary team how to explain dermatologic management strategies in layman's terms habit of accepting all consults and take the initiative to remain professional and pleasant during interactions; model behavior for junior residents Demonstrate interestEngage with the primary team in asking clarifying questions and showing interest in the consult question during the initial conversation. Respond enthusiastically to questions from the primary team and take the opportunity to teach about dermatologic diseases Build in time for learning When conveying the assessment and plan, ask if the primary team has time to discuss interesting learning points.…”

Barriers to hospitalist fellow interactions

“…Editor – I read with interest the report of resident‒fellow teaching interactions published by Miloslavsky et al . I applaud the group for working to improve resident education through consultant services.…”

“…As attending physicians, hospitalists are a step above fellows in the hierarchical hospital structure, which could limit fellows’ confidence in their role as teachers and hospitalists’ confidence in their role as learners. Secondly, the primary team structure and familiarity between residents and fellows were identified as barriers to fellows teaching residents in the study by Miloslavsky et al ., and these challenges are even more profound in the hospitalist‒fellow dynamic. Although many fellows completed residency at the same institution and are likely to know the location of resident workrooms and the structure of resident schedules, they are less likely to have access to this data for hospitalists, making face‐to‐face encounters more challenging.…”