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Improving Consultation Communication Skills

Javier Benitez, MD |

Talking to colleagues is an essential skill especially as we advocate for our patients. We should not only know what’s going on with our patients, but also how to communicate our thoughts effectively and succinctly with our colleagues. In a great article by Dr. Chad Kessler et al 1 just published Academic Medicine, the authors state that although “communication skills may not develop naturally, [they] can be taught and fostered through evidence-based educational models.”

Working on improving communication skills is especially in the emergency department because of its high volume of consults. Without adequate training, miscommunications both on the telephone and in person can lead to significant delays and errors in patient care. 2

The article reviews the 5Cs of consultation (Contact, Communication, Core question, Collaboration, Closing the loop) which were previously published by Kessler et al. Added in this article is the PIQUED approach, an educationally focused communication-method developed by Chan, et al 3  which stand for:

  • P: Preparation before the encounter
  • I: Identification of involved parties
  • Q: Questions (Clinical question; Answering questions)
  • U: Urgency of the request
  • E: Educational modification
  • D: Debrief and Discuss

The authors then proposed a mixed model, combining elements from both validated models (5C’s, PIQUED), which hopefully can be externally validated in ED’s as well as other settings: 

1. Preparation 

  • Perform initial work up and resuscitation
  • Review investigations

2. Contact and Communication

  • Contact and communicate with colleague about patient

3. Core questions

  • Address questions or concerns

4. Collaboration

  • Be open to recommendations and collaboration

5. Urgency

  • Modify behavior and information on the basis of urgency

6. Closing the loop

  • Review agreed-on plan and thank consultant for time and help

7. Educational modifications

  • Make adjustments for colleagues (especially junior ones)

8. Debrief and discuss

  • Elicit or provide feedback regarding case


The practice of medicine keeps getting more complex. The volume of information keeps getting greater, forcing a more team-based approach to patient care. Medical educators are always on the look out for ways to improve medical education with the end goal of taking care of patients safely and efficiently.

I agree with the authors that this tool should be further explored and integrated into the curriculum. Consultation communication skills are an essential part of our practice and should also be an essential part of our training.

A great listen:
Dr. Kessler discusses communicating with consultants on EMRAP:EE podcast (Feb 2010). It is very informative, educational, and full of practical advice.


Image by David Cosand

Kessler C, Chan T, Loeb J, Malka S. I’m clear, you’re clear, we’re all clear: improving consultation communication skills in undergraduate medical education. Acad Med. 2013;88(6):753-758. [PubMed]
Kessler C, Afshar Y, Sardar G, Yudkowsky R, Ankel F, Schwartz A. A prospective, randomized, controlled study demonstrating a novel, effective model of transfer of care between physicians: the 5 Cs of consultation. Acad Emerg Med. 2012;19(8):968-974. [PubMed]
Chan T, Orlich D, Kulasegaram K, Sherbino J. Understanding communication between emergency and consulting physicians: a qualitative study that describes and defines the essential elements of the emergency department consultation-referral process for the junior learner. CJEM. 2013;15(1):42-51. [PubMed]

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Javier Benitez, MD

Javier Benitez, MD

ALiEM Featured Contributor

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