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I’m Clear, You’re Clear, We’re All Clear: Improving Consultation Communication Skills in Undergraduate Medical Education

Kessler, Chad S. MD, MHPE; Chan, Teresa MD; Loeb, Jennifer M.; Malka, S. Terez MD

doi: 10.1097/ACM.0b013e31828ff953

Requesting and providing consultations are daily occurrences in most teaching hospitals. With increased attention on transitions of care in light of the recent scrutiny of duty hours, consultations and other interphysician interactions, such as handoffs, are becoming increasingly important. As modern medicine increases in complexity, the skill of communicating with medical colleagues throughout the continuum of care becomes more challenging. Like many of the other skills acquired by medical students, consultation communication is often learned by casual observation and through trial and error. Without formal training, however, miscommunications will continue to occur, nearly ensuring that medical errors happen. Interphysician communication skills, therefore, need to be emphasized in undergraduate and graduate medical education instead of being left to happenstance or hit-or-miss practice. In this article, the authors review two models for understanding and teaching the consultation process—5Cs and PIQUED—both of which were developed for specific subsets of learners. They then combine the two to create a consultation model that may be more widely applied.

Dr. Kessler is deputy chief of staff, Durham VA Medical Center, Duke University, Durham, North Carolina.

Dr. Chan is a resident, Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.

Ms. Loeb is a medical student, College of Medicine, University of Illinois–Chicago, Chicago, Illinois.

Dr. Malka is a resident, Department of Emergency Medicine, Department of Pediatrics, Indiana University, Indianapolis, Indiana.

First published online April 24, 2013

Correspondence should be addressed to Dr. Kessler, Durham VAMC, 580 Fulton St., A 10 009, Durham, NC 27705. Fax: (919) 416-8055; e-mail:

© 2013 Association of American Medical Colleges