Inspired by the Harvard Business Review Cases and led by Dr. Teresa Chan (@TChanMD) and Dr. Brent Thoma (@BoringEM), the Medical Education In Cases (MEdIC) series puts difficult medical education cases under a microscope. On the fourth Friday of the month we will pose a challenging hypothetical dilemma, moderate a discussion on potential approaches, and recruit medical education experts to provide “Gold Standard” responses. Cases and responses will be made available for download in pdf format – feel free to use them!

If you’re a medical educator with a pedagogical problem, we want to get you a MEdiC. Send us your most difficult dilemmas and help the rest of us to bring our teaching game to the next level. 

The Case

Consultation skills are difficult to master.  One of the few things more difficult than acquiring this skill is teaching it. The first case of the MEdiC series poses just this dilemma. 

“Well… That did not go as I expected!” exclaimed Melanie. Melanie, an off-service first-year rotating through the emergency department, as she hung up. The strength with which the phone was slammed down suggested that it had gone much worse than she had expected.

“What’s wrong?” asked Geoff, a third year resident in Emergency Medicine, “You sounded like you were getting some push-back from the senior medicine resident, eh?”

“Yeah. I mean, I’ve called for consults before on the ward… but that was so much more difficult that usual,” she reflected. “He just kept on asking me question after question… He wanted the exact blood pressure of the patient, and when I couldn’t give it, he made some snarky response about how I should ‘know better’… Does that happen to you?”

“It used to happen a lot, but I think over the years I’ve found a way to give consults so that everyone seems to walk away happy,” replied Geoff. “Honestly, I don’t really know when that transition happened. But now, I just seem to get the consults I want, when I want them… Still, sometimes, even I have consults that don’t seem to go so well.”

Melanie leaned back and sighed. “There must be something you do differently. I can’t imagine doing this job everyday if I had to get that kind of push-back every time I talked to another doctor.”

You observe this interaction between Geoff and Melanie. 

Questions for Discussion

  1. What would you do if you were faced with The Case of the Difficult Consult?
  2. What advice would you give these two learners? 
  3. How would you intervene? 
  4. What wisdom would you share with them?

I look forward to hearing your thoughts over the weekend.*

Next Week*

We will post responses from two medical education experts who have published on the topic of consultation education.

  • Dr. Rob Woods (@robwoodsuofs) has a MMEd from the University of Dundee and is the Emergency Medicine Program Director at the University of Saskatchewan
  • Dr. Teresa Chan (@TChanMD) is working on her MHPE at the University Illinois at Chicago and of is a recent grad of the McMaster Emergency Medicine program

Thanks to Dr. Teresa Chan (@TChanMD) for inspiring this case series and drafting this first case. We will be sharing writing/editing/recruiting duties for this series from here on out!


All characters in this case are fictitious. Any resemblance to real persons, living or dead, is purely coincidental.

*The ‘official’ response week ended on Sept. 6, 2013 when our subsequent expert & curated community commentary was released.  That said, you are very welcome to continue the conversation in the comment section below.  We’ve had an unprecedented response (40 comments as of September 10, 2013).


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Brent Thoma, MD MA
ALiEM Associate Editor
Emergency Medicine Research Director at the University of Saskatchewan
Editor/Author at
Brent Thoma, MD MA