Conquering Consultations: A Guide to Advances in the Science of Referral-Consultation Interactions for Residency Education

Ann Emerg Med. 2019 Jul;74(1):119-125. doi: 10.1016/j.annemergmed.2018.12.004. Epub 2019 Jan 17.


Consultations with specialist services occur with regularity in the emergency department (ED). Emergency physician interactions with consultants in the ED offer an amazing opportunity for collegial patient care but can also present a number of challenges. Navigating the consultation process requires effective communication skills that are considered a core competency within the Accreditation Council for Graduate Medical Education, as well as the CanMEDS frameworks of the Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada. Because of time pressure, environmental complexities, patient acuity, and the fast pace of the ED, learning this skill can be challenging for trainees and is something many attending physicians will struggle with at times. It has been established that trustworthiness and familiarity are 2 key components within the referral-consultation process. Both components rely on reputation, which creates a challenge in a training environment in which one's knowledge base and clinical acumen is a constant work in progress. Moreover, poor communication contributes to problematic patient care and decreased patient satisfaction. Knowing this, we believe it is imperative that residents be formally trained in this important skill. In this article, we introduce and highlight the most recent advances in standardized approaches to the referral-consultation process, including the 5C (contact, communicate, core question, collaborate, close the loop), PIQUED (prepare, identify, question, urgency, educational modifications, debrief), and CONSULT (contact courteously, orient, narrow question, story, urgency, later, thank you) models. Common roadblocks and complicating factors involved in resident-consultant interaction are also reviewed, ending with best-practice recommendations for consultants involved in resident education, as well as free open access medical education resources.

MeSH terms

  • Canada / epidemiology
  • Clinical Competence / standards*
  • Education, Medical, Graduate / organization & administration*
  • Emergency Service, Hospital / standards
  • Humans
  • Internship and Residency / standards*
  • Patient Satisfaction / statistics & numerical data
  • Physicians
  • Practice Guidelines as Topic / standards
  • Randomized Controlled Trials as Topic
  • Referral and Consultation / standards*
  • Referral and Consultation / trends
  • Social Skills
  • Trust / psychology