Abstract Rationale Inpatient subspecialty consult services present valuable opportunities in clinical learning and personal development for trainees yet dedicated training on the optimal inter-trainee relationship remains limited. The consulting fellow must fill multiple roles - including patient care, team management and coordination with others, teaching, and their own education. Residents likewise may carry ill-defined roles and are often tasked with similar, competing obligations. Despite cultural and institutional efforts to enhance consult-based teaching, we hypothesize gaps persist in educational delivery and experience across training levels. We seek to identify shared experiences of trainees on our inpatient pulmonary consult team that may inform future educational interventions. Methods We conducted virtual, individual, qualitative, semi-structured interviews of learners at our single-center academic health system. Pulmonary critical care fellows and internal medicine residents were included for a total of fifteen participants (N = 5, N = 10 respectively). Standardized questions were used to guide interviews and highlighted four main domains: overall experience, patient experiences/learning opportunities, consult-based relationships, and feedback. Responses were transcribed, compiled, and coded thematically in an inductive, agnostic manner. Results From our fellow perspective, five qualities were identified when describing ideal residents on consult services: engaged, intellectually curious, accountable, proactive, and independent thinkers. From our resident interviews, four recurring characteristics emerged describing their optimal fellow counterparts: strong communication, availability/accessibility, mutual respect, and ability to provide coaching/guidance. Fellow-to-resident feedback was viewed as mutually beneficial but infrequently practiced (requested or received). Both early and advanced learners described overlapping challenges including unclear expectations, unpredictable workload, undefined student roles, and inconsistent feedback. Notably, neither learner level consistently commented on medical knowledge or specific skill provision as features of a highly functioning team member. Conclusions Consult services, especially those with tiered learners, are frequently heterogenous and may lack frameworks in place to optimize the trainee experience. Time on consult rotations can provide subject understanding, subspecialty interest development, and maturation of leadership skills, highlighting the importance of an intentional educational model. Our findings suggest residents and fellows value effective communication, mutual effort, and clearly established team dynamics as pillars to success. Similar findings have been suggested in response team and critical care settings, including expectation setting, where we would posit the same principles apply to our non-emergent environments. In next steps, we are using these data to consider future interventions - curriculum, orientation tools, expectation-setting frameworks, refined roles - to enhance our multi-level learner teams and the education of trainees. This abstract is funded by: none
Way et al. (Fri,) studied this question.