Consultation Practice Research Articles

Knowledge, risk perceptions and practices regarding rodents and their associated pathogens: environmental consultants in Chile

BackgroundRodents play essential ecological roles but are also significant reservoirs of zoonotic pathogens, posing risks to humans. Individuals with frequent occupational contact with rodents face an elevated risk of exposure to rodent-borne diseases. This study examines the knowledge, risk perceptions, and practices of Chilean environmental consultants (ECs) concerning rodents and rodent-borne diseases.MethodsA 32-item questionnaire, which focused primarily on biologists, veterinarians, and environmental engineers, was administered. The questionnaire included closed, open-ended, and semi-open-ended questions. Data analyses, performed using R software, involved calculating frequencies and proportions for questions related to knowledge of rodents and rodent-borne diseases, rodent management and handling, biosafety procedures, and training. Additionally, generalized linear models (GLMs) were used to assess knowledge of rodent hosts and diseases, whereas correspondence analysis was used to examine associations between EC characteristics (undergraduate fields of study and years of experience) and responses regarding risk perception and the importance of zoonotic disease training.ResultsCompleted questionnaires were received from 206 ECs. Although the ECs demonstrated a strong awareness of hantavirus cardiopulmonary syndrome, identifying it as a significant rodent-borne threat, knowledge gaps were evident regarding the specific role of certain rodent reservoir species and other rodent-borne diseases in Chile. For example, leptospirosis was well recognized, particularly among veterinarians, whereas emerging zoonoses such as scrub typhus was rarely mentioned. The study also revealed the frequent use of live trapping and direct handling of rodents, resulting in injuries to 32% of the respondents. Despite the widespread use of personal protective equipment, key elements such as respiratory protection and disposable suits were underutilized, and inadequate cleaning practices for traps were reported. Nevertheless, ECs expressed a willingness to participate in zoonotic disease training, underscoring the need for further education.ConclusionsThis study highlights the critical need for ongoing education for ECs on rodent reservoirs, diseases, and biosafety measures to enhance their safety and reduce the risk of zoonotic infections. The findings offer valuable insights for developing strategies aimed at improving awareness and strengthening biosafety practices within this occupational group.

Turkish Translation and Validation of the Expectations of Aesthetic Rhinoplasty Scale.

The aim of this study was to translate, validate, and culturally adapt the original English version of the Expectations of Aesthetic Rhinoplasty Scale (EARS) into Turkish for use in Turkish-speaking communities. Fifty-one patients who wanted to undergo primary rhinoplasty and were literate in Turkish were included in the study. The control group consisted of 81 healthy volunteers who did not require rhinoplasty. A Turkish version of the EARS (EARS-T) was created. The participants completed the EARS-T questionnaire twice, 4-week apart. The internal consistency of the scale (Cronbach's α), the test-retest reliability (intraclass correlation coefficient [ICC]), and differences between the patient and control groups (Pearson's chi-square test) were analyzed. A statistically significant difference was found between the age and gender of the patient and control groups (p = 0.001 and 0.001, respectively). Univariate analysis showed that this significant difference did not affect the study results (age: p = 0.2; gender: p = 0.12). In addition, a statistically significant difference was found between the scale scores of the control and rhinoplasty groups (all p < 0.05). The EARS-T had good internal consistency, with high Cronbach's α scores ranging between 0.74 and 0.87. Test-retest reliability was demonstrated by high ICC scores ranging from 0.71 to 0.87. Our study revealed that the EARS-T has good internal consistency, reliability, and validity. Therefore, it can be used to assess the expectations of aesthetic rhinoplasty patients in preoperative consultation practice and in clinical studies related to rhinoplasty.

Discussing poverty within primary-care consultations: implications for mental health support.

Poverty can have significant impacts on health and wellbeing. However, asking patients about their broader socio-economic circumstances is not routine within primary care consultations. To understand healthcare professionals' experiences of communicating with patients about their socio-economic circumstances and how a bespoke training programme supported these conversations in routine consultations. Healthcare professionals from 30 GP practices across England received training to improve understanding and communication with patients about the ways that poverty impacted their mental health. Semi-structured interviews were undertaken with 49 GPs and allied health professionals to understand barriers and enablers to communication around poverty and the impact of the training on their consultation practice. Health professionals often lacked confidence in discussing socio-economic issues and welcomed information on how to do this sensitively. Asking questions relating to poverty-related stresses was felt to lead to better understanding around the causes of mental distress, avoidance of problematic assumptions and inappropriate antidepressant prescribing and to enable more coordinated and appropriate support from practice teams. Asking patients about their socio-economic circumstances can facilitate provision of appropriate support.

Consultative roles of early childhood special education teachers: A modeler, an advisor, and a spontaneous practitioner

This study focused on the ways in which early childhood special education teachers (ECSETs) perform their consultative work and the prevailing structural factors that are connected to it. The significance and centrality of ECSETs’ consultative work have increased as a growing number of ECSETs provide consultative support to other personnel with the aim of enhancing support for children's daily lives in early childhood education and care (ECEC). However, we have limited research-based knowledge about the consultative work done by ECSETs. Therefore, a more comprehensive examination of consultative practices and the factors influencing them is needed. We administered a survey on ECSETs’ (N = 207) consultative work focusing on ECEC in Finland. Using cluster analysis, we identified three consultative work profiles in ECSETs’ practices: a modeler, an advisor, and a spontaneous practitioner. This exploratory study contributes to understanding ECSETs' consultative work, creating potential for further development in this area.

OGC SO16 - International upper GI robotic fellowship on the CMR Versius platform

Abstract Background The impetus for UGI surgery trainees to attain skills in robotic surgery is likely to increase following the global acceptance and utilisation of robotic platforms. UGI robotic fellowship programs are few in number and highly desirable providing trainees with a unique selling point when embarking on independent consultant practice. We describe the first UGI robotic surgery fellowship on the CMR Versius platform at the Gloucestershire Royal Hospital which has the largest experience of UGI robotic surgery on the CMR Versius platform in the UK, having performed over 200 cases including the first robot assisted minimally invasive oesophagectomy. Method A structured robotic training curriculum was created in collaboration with CMR Versius. It consists of a pre-clinical phase of E-learning (10 modules), simulator training (16 assessed tasks) and dry-laboratory training (a two-day course encompassing robotic system set-up, bed-side assist and assessed dry lab practical tasks). The clinical phase begins with bed-side assisting of robotic cases followed by supervised operating on the console. Operations performed on the console are recorded for review and evaluation. The videos will be scored by two independent surgeons using the modified Global Evaluation Assessment of Robotic Skills (mGEARS) score to track growth and progress. Results The E-learning modules and assessments were completed prior to commencement of the fellowship. The remainder of the pre-clinical phase of the curriculum were completed within 4 weeks of commencement followed by bed-side assisting. Once competent at bed-side assisting and able to demonstrate proficiency in set-up (selecting port site placement, docking, arm spacing and configuration), supervised console training was commenced 6 weeks into the fellowship. Console training began with robotic assisted laparoscopic assisted cholecystectomy to gain familiarity, confidence, and efficiency. After 6 cases as the only console surgeon, the surgical complexity of cases was progressed to hiatal surgery and Heller’s cardiomyotomy Conclusion A structured training curriculum with defined phases provides a feasible and effective framework for robotic fellowship training. Adherence to the pre-clinical phase of training allows safe and efficient progression to hands-on console experience. This is achievable within relatively short timeframe to allow for ample independent console surgeon experience and the development of proficiency within a 12-month fellowship period.

Teaching innovation: enhancing undergraduate student pharmacist consultation skills by introducing ‘Fishbowl’ prescribing workshops

Abstract Introduction The new ‘Standards for the initial education and training of pharmacists’1 outline the skills, knowledge, and attributes required to enable pharmacists to independently prescribe at the point of registration. Third-year MPharm students at the University of Nottingham have previously practised consultation skills in professional practice workshops, conducting shorter form, over the counter-type consultations. These lacked the depth required for pharmacy students to develop skills they will now need. Therefore, we identified a requirement for advanced consultation practice, including prescribing, alongside clinical history taking, to better prepare students to be prescribers. Creation of a new module occurred, ‘Pharmaceutical Care and Prescribing’, including ‘Fishbowl’ workshops. ‘Fishbowl’ is a small group teaching method where an individual student engages in a discussion, while observers form a circle around them2. Students were able to ‘tap out’ of consultations at any point, to discuss consultation direction with their peers. Five case studies were written to incorporate a variety of clinical conditions, patient demographics and clinical settings, with a key emphasis of holistic, patient-centred care. All third-year students were timetabled for five workshops, in groups of around 25. Facilitators regularly discussed consultation progress, outstanding care issues and gave feedback on areas done well or needing improvement. Aim Do students perceive ‘Fishbowl’ workshops to enhance their clinical history taking skills and prescribing knowledge? Methods Following the five workshops, all third-year students (n=256) were invited via email to complete a Microsoft Forms questionnaire, to evaluate the workshop aims . The questionnaire included ten 5-point Likert-scale questions and free-text answers. Primarily quantitative methods were used with free-text responses used to contextualise results. This study obtained ethical approval from the University of Nottingham, School of Pharmacy Postgraduate Research Projects Ethical Approval group. Results 82 students (32%) completed the questionnaire. 91% of students felt they helped practice taking a clinical history. 80% of students felt they better understood how to include share care decision making into their consultations. One student commented, they were ‘very thought-provoking sessions and easy to interact and learn from each other’. 67% said the sessions helped them to better understand the pharmacist’s role in prescribing. With regards to prescribing awareness, a student commented ‘It would have been nice to have scenarios where we prescribed a POM in the end for more of the sessions to help us get used to thinking like prescribers.’ 85% of students would recommend the teaching technique to other MPharm students, 76% felt these sessions should be introduced in earlier years of the MPharm course. A few students commented that the facilitation style varied considerably depending on academics involved. Discussion/Conclusion ‘Fishbowl’ method of teaching provides a suitable environment for practising clinical history taking and prescribing and were generally well received by students. Further work is needed to integrate this teaching technique earlier in the MPharm programme. Facilitator skills play a significant part in student engagement, we need to ensure there is appropriate staff training to run this session type. Limitations of the study include lack of comparison against other student teaching tools.

Current Status of Neonatal Music Therapy Services Within the US

Abstract Over the past 30 years, music therapy services in the neonatal intensive care units (NICUs) have expanded, yet there is still limited literature available that captures current practice trends in this setting. The purpose of this paper was to obtain descriptive data about current demographics, consultation, and clinical practice trends in NICU music therapy clinical practice in the US. A questionnaire was sent to 9,222 Board-Certified Music Therapists. Those providing music therapy services in the NICU and choosing to participate (N = 87) completed the questionnaire. Results showed that a majority of music therapists working in the NICU who responded to the questionnaire have completed additional training to provide specialized services. Most NICU music therapists reported spending less than 20 hr a week on the unit and providing a variety of family-centered interventions to infants starting at 28 weeks postmenstrual age (PMA). Common diagnoses for referral besides prematurity were Neonatal Opioid Withdrawal Syndrome and Chronic Lung Disease. Music therapists are well integrated within treatment teams with a majority reporting collaborating and/or co–treating with other therapies and/or clinical staff.

Streamlining Preoperative Evaluation for Dialysis Access: A Pilot Study

Outpatient in-person clinic evaluation is the standard consultation practice for an initial referral for hemodialysis (HD) access. However, most factors predicting the complexity of first-time access surgery can be determined from history rather than physical exam. This study compares the outcomes of patients undergoing first-time arteriovenous fistula creation screened with a standardized preoperative phone interview and no preoperative clinic visit (SPEEDY group) to those opting for a standard in-person clinic visit. From September 2021 to August 2022, all patients scheduled in our vascular surgery clinic for first-time dialysis access were interviewed via telephone using a standardized history questionnaire. Those meeting criteria and expressing desire to bypass the initial clinic visit were scheduled for surgery without an in-person preoperative evaluation (SPEEDY group). The comparison group included patients who were study-eligible but desired to meet with the surgeon preoperatively. Time from referral to fistula creation, overall fistula patency rates, and the incidence of access-specific complications were compared between the 2 groups. Of the 107 patients contacted, 43 (40%) were study eligible. Of these eligible patients, 21 (49%) were scheduled for surgery without a preoperative visit, of whom 19 (90%) underwent surgery. Compared to eligible controls, SPEEDY patients had a younger median age (49.3years vs. 58.9, P=0.056) but similar median duration of HD prior to fistula creation. SPEEDY patients had a significantly shorter median time from initial referral to surgery than eligible controls (48days vs. 82, P=0.01). Incidence of complications did not differ between the groups. At a median follow up time of 18.3months (IQR 11.4-20.9) there was no difference in overall access patency between SPEEDY participants and eligible controls (P=0.83). A standardized telephone questionnaire can effectively be used to identify patients who can safely undergo first time dialysis access surgery without an in-person clinic evaluation, significantly reducing time from initial referral to surgery without increasing complications or compromising patency rates.

Everyday Ethics or Deference to Expertise: Experiences of Pediatric Palliative Care Teams with Ethics Consultancy.

Background: Little is known about the extent to which pediatric palliative care (PPC) clinicians are engaged in ethics consults or how they perceive interactions with ethics consultants. Objective: Describe the extent to which PPC team members serve in pediatric health care ethics (PHCE) consultancy roles and to describe their experiences interacting with pediatric ethic consultant services. Design: Online survey distributed to members of the American Academy of Pediatrics and American Academy of Hospice and Palliative Care pediatric and ethics section and special interest groups in the United States. Results: Eighty-six responses were obtained (response rate 45%) from PPC teams in 70 different children's hospitals located in 34 states. Almost all (97%) reported a functional ethics consult service such that PPC is not expected to meet the ethics need of the institution. A person involved on the PPC team also performed ethics consults in half (49%) of the settings, predominantly the PPC physician. Most respondents who perceive PPC teams engage in ethics-relevant work as part of their everyday PPC work. Formal ethics training was lacking among PPC members involved in ethics consults with few ethics degrees (15%), certifications (6%), or fellowships (2%). Discord (67%), conflict (49%), limitations to treatment (48%), and distress (41%) were cited as the most frequent reasons for which PPC teams consult ethics. PPC respondents identified role clarity, coordinated engagement, timely presence, and open communication as strong PHCE consultant practices. Conclusions: PPC team members performing ethics consults may benefit from additional ethics education and training. Further research is warranted to delineate scope of ethics consultancy relevant to PPC and role clarity.

A National Survey of Interventional Radiology Trainees on Peripheral and Aortic Endovascular Training.

The development of technical skills in peripheral and aortic endovascular intervention is an essential part of interventional radiology (IR) training. Access to endovascular training remains contentious, with IR and vascular surgery (VS) trainees competing for opportunities. The Collaborative Peripheral and Aortic Endovascular Training Survey (CPAETS) aimed to evaluate IR trainees' experiences, expectations, and barriers to endovascular training. CPAETS was a joint survey between the British Society of Interventional Radiology and the Rouleaux Club (UK Vascular Trainees' Association), open for 12 weeks and distributed to UK-based IR and VS trainees. This article focuses on IR trainee responses. Thirty-two responses were received from IR trainees across England, Scotland and Wales. Overall, 59% of respondents were satisfied with their endovascular training. IR trainees reported less regular hands-on experience of aortic endovascular procedures (50%) compared to peripheral endovascular procedures (93%). Consequently fewer trainees (65%) felt confident in achieving the necessary aortic endovascular competencies by the end of their training, compared to peripheral procedures (89%). Limited exposure to aortic endovascular procedures resulted in reduced confidence levels in performing aortic intervention as compared to peripheral procedures. Potential solutions to bridge some of these IR training gaps include greater pre-operative and post-operative presence, the use of simulators and IR fellowships to ensure adequate training opportunities. This article provides a snapshot of the current gaps in IR endovascular training in the UK, with insight into solutions that can enable trainees to develop clinical and technical competencies required for IR consultant practice.

General practitioners’ knowledge and practice in consultations with (potential) torture victims: a qualitative pilot study from Norway

Background According to the UN Committee Against Torture, all state parties to the Torture Convention have a responsibility to meet the rehabilitation needs of torture victims who have sought asylum within their borders. General practitioners (GPs) can play a crucial role in identifying torture victims and securing rehabilitation when needed. There is a pressing knowledge gap on the knowledge and practices of GPs vis-à-vis potentially tortured patients, and an urgent need for research that investigates GPs’ practices of identification, referral, and rehabilitation – in Norway and beyond. This article presents an exploratory qualitative pilot study that investigates the experiences of GPs in Oslo vis-à-vis this patient group. Methods Semi-structured interviews with five experienced GPs in the greater Oslo area. Interview data was analyzed through thematic analysis and discussed within a theoretical framework seeing GPs as street-level bureaucrats. Results Issues that emerged in the pilot involve a consistent professional confidence and a particular concern for victims of sexual violence and sexualized torture. The pilot also found a troubling commonsensical reasoning about identification in the asylum process. The GPs asked for the re-establishment of specialist rehabilitation centers for refugees and torture victims to consult in case of need. Alas, the study also confirmed that GPs are a difficult profession to recruit for research. Conclusions This study indicates that GPs are important actors in terms of identifying torture victims after resettlement, but that there are shortcomings in their training and knowledge, in the overall organization of the healthcare system, and in specialized healthcare, that limit prospects for rehabilitation.

Consultation Training to Develop Change Agents: Introduction to the Special Issue

ABSTRACT The competent practice of school consultation, including at a systems level, is presumably predicated on effective consultation training. This article overviews the rationale for a special issue on consultation training to develop change agents in schools, and briefly previews the articles published within the issue. Taken together, the articles in the issue provide directions that can guide future research and practice in this area.

Hidden Fault Lines in the Bedrock: A Critical Examination of Surrogate Decision-Making Standards in Ethics Consultation.

AbstractClinical ethicists are routinely consulted in cases that involve conflicts and uncertainties related to surrogate decision-making for incapacitated patients. To navigate these cases, we invoke a canonical ethical-legal hierarchy of decision-making standards: the patient's known wishes, substituted judgment, and best interest. Despite the routine application of this hierarchy, however, critical scholarly literature alleges that these standards fail to capture patients' preferences and surrogates' behaviors. Moreover, the extent to which these critiques are incorporated into consultant practices is unclear. In this article I thus explore whether, and how, existing critiques of the hierarchy affect the application of these standards during ethics consults. After discussing four critiques of the hierarchy, I examine how two prominent published ethics consultation methodologies-bioethics mediation and CASES-incorporate these critiques differently. I then argue that while both methodologies explicitly endorse the same hierarchy, the varying degrees to which these four criticisms are incorporated into the prescribed consultation process could produce different applications of the same standard. I demonstrate with a case study how an ethics consultant following either methodology might produce two substantively different recommendations despite using the same substituted judgment standard. I conclude that while this heterogeneity of application should not dismantle the hierarchy's status as field-wide canon, it complicates projects of professional ethics consultation consensus building.

Upper gastrointestinal training in the UK and Ireland: a Roux Group Study.

Surgical training programmes in the United Kingdom and Ireland (UK&I) are in a state of flux. This study aims to report the contemporary opinions of trainee and consultant surgeons on the current upper gastrointestinal (UGI) training model in the UK&I. A questionnaire was developed and distributed via national UGI societies. Questions pertained to demographics, current training evaluation, perceived requirements and availability. A total of 241 responses were received with representation from all UK&I postgraduate training regions. The biggest discrepancies between rotation demand and national availability related to advanced/therapeutic endoscopy and robotic surgery, with 91.7% of respondents stating they would welcome greater geographical flexibility in training. The median suggested academic targets were 3-5 publications (trainee vs consultant <3 vs 3-5, p<0.001); <3 presentations (<3 vs 3-5, p=0.002); and 3-5 audits/quality improvement projects (<3 vs 3-5, p<0.001). Current operative requirements were considered achievable (87.6%) but inadequate for day one consultant practice (74.7%). Reassuringly, 76.3% deemed there was role for on-the-job operative training following consultant appointment. Proficiency in diagnostic endoscopy was considered a minimum requirement for Certificate of Completion of Training (CCT) yet the majority regarded therapeutic endoscopy competency as non-essential. The median numbers of index UGI operations suggested were comparable with the current curriculum requirements. Post-CCT fellowships were not considered necessary; however, the majority (73.6%) recognised their advantage. Current CCT requirements are largely consistent with the opinions of the UGI community. Areas for improvement include flexibility in geographical working and increasing national provisions for high-quality endoscopy training.

In situ acoustic characterization of a perforated panel on a cavity by means of PU measurement and model fitting

The in situ characterization of materials is a crucial challenge in room acoustics, as laboratories measurement cannot always be applied in consultancy practices. In particular, there is a lack of method to characterize in situ systems with perforated facings, which are commonly encountered systems in room acoustics. In this paper, the in situ characterization of a rigidly-backed porous material behind a rigid perforated facing by means of pressure–velocity measurements is presented. The method includes an inverse impedance model fitting based on measurement in a limited frequency range. The applicability of this method was studied by measuring a variety of perforated facings, whether in front of an air cavity or backed by a porous layer, and comparing the obtained impedance model parameters to reference values. Good agreement was observed between the retrieved parameters and the references, with the errors in all retrieved parameters moving mass, facing thickness, cavity depth, porous layer thickness and porous layer flow resistivity not exceeding 15%.

661: Impact of Advanced and Consultant Practice Roles within Radiation Oncology across the SE Region (UK)

661: Impact of Advanced and Consultant Practice Roles within Radiation Oncology across the SE Region (UK)

Consultant practice in heart failure: reflections and evidence

New opportunities for consultant practice roles in heart failure services are lacking in the UK, but posts are developing across the country. This article discusses consultant practice, using reflective accounts from two consultant nurses who practice in different care settings to explore how their experiences led to their current roles. The definition of consultant practice and how ‘imposter syndrome’ could impact success are also discussed.

Telemedicine and Patient Experience Ratings at an Academic Integrative Medicine Practice: Retrospective Examination.

The use of telemedicine (TELE) increased exponentially during the COVID-19 pandemic. While patient experience with TELE has been studied in other medical disciplines, its impact and applicability to integrative medicine practices remain unknown. The aim of this study is to assess the impact of visit modality, TELE versus face-to-face (F2F) encounters, on patient experience at an integrative medicine practice at a single academic medical center. Given the significant role of the patient-physician relationship, therapeutic presence, and touch in integrative medicine, we hypothesized that TELE would result in reduced patient experience compared to traditional F2F encounters. A retrospective examination of Press Ganey surveys at an academic, consultative, and integrative medicine practice was conducted. Anonymous surveys completed by patients, older than 18 years of age, who had TELE or F2F appointments from April 1, 2020, to March 31, 2023, were included. At our medical center, patients commonly travel in from out of state for complex care. We examined percentage "top box" scores (ie, the percentage of respondents who selected the most positive response category on the survey, "very good"), across a variety of experience metrics. ANOVA and chi-square analyses were completed, with a significance threshold of P<.05. Over the 36 months, a total of 1066 surveys were completed and returned (TELE: n=333; F2F: n=733). Overall, 73% (n=778) of respondents were female with an average age of 57.6 (SD 13.84) years. Most patients were English-speaking (n=728, 99.3%), White (n=1059, 92.7%), and not Hispanic or Latino (n=985, 92.4%). There was significantly higher satisfaction with access to care for TELE visits compared to F2F visits. There were no differences in satisfaction with the care provider or in overall experience. When examining the specific aspects of using technology during TELE visits, there were no differences in audio quality, visual quality, or ease of talking to the care provider based on sex. There was, however, a difference in video quality based on age, where those 80 years and older rated significantly lower video quality compared to all other age groups. Top-level patient experience can be attained with TELE integrative medicine visits. Additional studies, particularly those correlating positive experience findings with specific behaviors used during TELE visits, would further our understanding of the integrative medicine patient experience. In the meantime, efforts should be made to ensure a policy that promotes the ongoing provision of TELE in integrative medicine.

Relative Value of Point-of-Care Ultrasound in Person Specification of UK Consultant Job Advertisements Across Multiple Acute Specialties.

Background Point-of-care ultrasound (POCUS) skills are very useful in the management of acute patients. It is unknown how highly valued they are at the consultant level. The objective of this study was to investigate the prevalence of POCUS skills being listed as essential or desirable in consultant job advertisements for acute medicine (AM), intensive care medicine (ICM), and emergency medicine (EM) in the United Kingdom (UK). Methods We investigated the frequency with which POCUS skills are listed in person specification of consultant jobs advertised in the UK in three acute specialties (AM, ICM, and EM). Data were collected prospectively between May and June 2022 from the NHS Jobs website. Results A total of 286 jobs were identified, and 11 jobs (3.85%) listed POCUS skills as either essential or desirable. In AM consultant jobs, only two (1.83%) categorized POCUS as desirable or essential compared to five (11.6%) in ICM and four (3%) in EM. Conclusion POCUS skills are mentioned in the person specification in a minority of consultant job advertisements in acute specialties and currently do not seem to be widely viewed as essential or desirable for consultant practice in these specialties. It may be due to not many consultants are currently trained for this new skill, which in turn has led to the scarcity of the skill set demanded by the employing trusts in the UK.

Consultation and Collaboration to Support Meaningful and Socially Valid Outcomes for Autistic People: Introduction to the Special Issue Part 2

ABSTRACT This introduction outlines Part 2 of the Special Issue centered on consultation and collaboration to support meaningful and socially valid outcomes for autistic people. In Part 2, four quantitative studies focused on strategies to promote generalization and sustainability of consultant and consultee skills are presented. Part 2 concludes with a commentary from autistic adults on future directions and considerations for consultative practices to facilitate meaningful and socially valid outcomes for autistic people.