(VP004) A NOVEL SIMULATION IN THROMBOSIS MEDICINE TO TEACH RESIDENTS HOW TO PROVIDE AN EFFECTIVE CLINICAL CONSULTATION

Background: Providing an effective Thrombosis consultation is an essential skill for trainees in our specialty, however teaching, direct observation, and feedback to residents on their consultancy skills is lacking in the workplace. There are no well-developed frameworks to help teach consultancy skills and there is little empirical work examining the role of simulation to teach trainees these skills. Our study aimed to 1) identify the critical competencies required to provide a consultation, and 2) create a novel simulation exercise to teach residents how to provide an effective Thrombosis consultation.

METHODS AND RESULTS: Independent dyads of residents and faculty members from McMaster University’s Department of Medicine participated in Thrombosis virtual simulated cases designed to assess medical consultation skills. Three cases were developed with feedback from Thrombosis faculty: unstable pulmonary embolism requiring thrombolysis, deep vein thrombosis in a patient with gastrointestinal bleeding and suspected colon cancer, and a telephone consultation involving a patient with a mechanical mitral valve on warfarin with an intracranial hemorrhage. Cases were developed with a view to sample diverse clinical contexts. Trainees and faculty then participated in individual semi-structured interviews, analyzed using qualitative framework analysis. Data were analyzed iteratively using a constant comparative method and an inductive approach. Simulations were conducted until theoretical saturation.

Results: Eight residents and eight faculty members participated (8 simulations). Participants reported a lack of teaching on consultancy skills. Many learned by observing their supervisors or peers. Simulation was viewed as an opportunity to gain clinical experience as a consultant in a low-stakes environment. Simulation offered a forum for direct observation of trainee performance on consultative skills and facilitated feedback. Participants were supportive of a simulation curriculum as an educational strategy to help trainees learn how to provide an effective consultation.
Critical competencies to provide an effective consultation include domain specific knowledge, understanding the reason for referral, being empathetic, providing specific recommendations, triaging, and teaching. Consultants operate on a continuum with respect to their involvement in direct patient care; their level of involvement influences the relative importance of each competency.

Conclusion: Simulation could be a promising modality to teach residents how to be effective thrombosis medicine consultants. Critical competencies of being a consultant identified could be used as a framework to teach trainees. Our cases could be adopted by other institutions to expose learners to clinical scenarios they may not otherwise see and help facilitate direct observation and feedback in Thrombosis AFC Fellowship programs.

Lay Abstract Content: Purpose of the research:
Like any other area of medicine, treating blood clots is both an art and a science. Physicians who treat blood clots, known as thrombosis physicians, must learn both the scientific aspects of treating patients, but they also must learn how to effectively provide advice to other doctors. Providing advice, also known as providing a consultation, is an important skill required of a thrombosis physician. Thrombosis physicians also supervise trainees (doctors in training) and are expected to teach them this skill. Currently, there is no specific curriculum to teach trainees how to effectively provide a consultation. There is also limited understanding of how simulation (role playing) can help teach trainees how to provide a consultation.
Relevance of the research:
Thrombosis physicians often act as consultants but have little training in how to be effective in this role. This research project will help provide a better understanding of the skills required to provide an effective consultation. We also hope to understand if simulation can help trainees become better consultants. This should lead to better teaching for trainees learning thrombosis medicine, and therefore lead to better trained doctors at the time of graduation.
General approach:
Trainees were asked to provide thrombosis medicine consultations in a simulated setting, while being observed by a supervising doctor. The supervisor gave feedback to the trainee on their performance. Following this, the trainee and supervisor were interviewed separately. The interviewer asked supervisors and trainees: 1) to identify the skills they felt were most important when providing a consultation, 2) their perception on the value of simulation to teach and assess consultation skills. Interview data was analyzed by looking for common themes.
Most participants were never formally taught how to be consultants and picked up this skill by watching others. Simulation was perceived as a useful tool to observe and teach consultation skills to trainees.
Key skills of being a good consultant include being a subject matter expert, knowing what advice people are seeking, being empathetic, providing specific advice, prioritizing sicker patients, and teaching.
Simulation is a promising tool to teach residents how to be effective thrombosis medicine consultants. Key aspects of being a good consultant could be used as a framework to teach trainees. Our simulation cases could be adopted by other schools that train thrombosis physicians to expose these trainees to clinical scenarios they may not otherwise see and facilitate direct observation and feedback.