Successful Consultation Research Articles

Using Performance Profiling to Assess Consultant Effectiveness

Despite its obvious value, the notion of assessing consultant effectiveness is not common practice nor is it well established as a research area in the field of Sport and Performance Psychology (SPP). Consultant effectiveness has been predominantly evaluated and chronicled by studying the characteristics (and behaviors) of successful mental performance consultants (MPCs). Although the vast majority of the performance profile (PP) literature highlights client-facing uses and benefits, the information presented herein outlines a novel practitioner-focused use and promising method of leveraging the PP procedure to gauge consultant effectiveness and provide MPCs with sensible informed guidance that can make a difference in the way that they evaluate themselves and their work. A case study is discussed to illustrate how the PP can be tailored to reflect evidence-based characteristics of effective consultants and how this feedback can benefit professional practice. Applied implications are outlined to provide MPCs practical guidance on how they can leverage the PP to appraise the quality of the working alliance and gain insight into their current consulting skillset to identify strengths and growth edges.

Establishment of the First Institution-Based Poison Information Center in Nepal Through a Multilateral International Partnership.

Toxicological emergencies present a significant health challenge in Nepal. Despite the high burden, the country has inadequate formal toxicology training, medical toxicology expertise, and adequate poison control infrastructure. In recognition of this need, the Nepal Poison Information Center (PIC) was established as a collaborative effort involving local and international partners. Through a comprehensive partnership framework, the Nepal PIC provides 24 hours a day, 7 days a week expert guidance to health care workers, conducts educational webinars, and engages in research. Initial data from the pilot phase indicate successful consultation delivery. Challenges include bureaucratic hurdles and the need for sustainable funding. Despite these challenges, the Nepal PIC demonstrates early feasibility and potential for expansion into a comprehensive toxicology center, contributing to the advancement of clinical toxicology in Nepal. Long-term sustainability relies on governmental support and continued advocacy efforts.

Successful consultancy: contracts and fees

Successful consultancy: contracts and fees

Enhancing Health and Exercise Consultation through Scenario-Based Learning: An Approach for Interpersonal Skill Development

This practice report describes the application of scenario-based learning to improve awareness of interpersonal skills in sport and exercise students. Thirty second-year undergraduate students over two consecutive academic years engaged in three scenario-based learning activities that simulated client interviews and consultations. The consensus among the students was that the scenarios increased their awareness of active listening, recognising physical client cues, and understanding the intricate dynamics of the ‘client-practitioner’ interaction. The implementation of scenario-based health and exercise consultations provided students with an immersive and effective learning experience, which promoted the development of the interpersonal skills required for successful client consultations.

Telemedicine in Follow-up after Spine Surgery: Need of the Hour.

Purpose There is an acute shortage of neurosurgeons and spine surgeons especially in rural areas of low- and middle-income countries including India. Patients of spine surgery need to travel long distances for follow-up at tertiary care hospitals. This study was done to evaluate role and success rate of telemedicine in follow-up after spine surgery based on patients' diagnosis and demographic features and to identify barriers to successful telemedicine consultations. Materials and Methods All patients undergoing spine surgeries including craniovertebral junction (CVJ) surgeries from January 2021 to June 2022 were included in the study. Success rate of telemedicine was calculated using a simple formula: Success rate of telemedicine = successful telemedicine consultations / total number of telemedicine consultation × 100. Success rate was evaluated with respect to demographic features and underlying disease-related factors. Results Eighty-four patients formed the study group in which a total of 181 video teleconsultations were done. Overall success rate of telemedicine was 82.87%. Higher socioeconomic and educational statuses were related to higher success rates of tele-consultations ( p < 0.05). Difficulty in assessing neurological condition using video call in follow-up cases of CVJ and issues related to Internet communication network leading to inability to video call and share image/videos were major causes of failures. Conclusion Telemedicine may prove an effective option for following up patients undergoing spine surgeries except CVJ, which is likely to improve further with improvements in Internet connectivity.

Royal Australian and New Zealand College of Psychiatrists professional practice guidelines for the administration of repetitive transcranial magnetic stimulation.

To provide guidance for the optimal administration of repetitive transcranial magnetic stimulation, based on scientific evidence and supplemented by expert clinical consensus. Articles and information were sourced from existing guidelines and published literature. The findings were then formulated into consensus-based recommendations and guidance by the authors. The guidelines were subjected to rigorous successive consultation within the RANZCP, involving the Section of ECT and Neurostimulation (SEN) Committee, its broader membership and expert committees. The RANZCP professional practice guidelines (PPG) for the administration of rTMS provide up-to-date advice regarding the use of rTMS in clinical practice. The guidelines are intended for use by psychiatrists and non-psychiatrists engaged in the administration of rTMS to facilitate best practice to optimise outcomes for patients. The guidelines strive to find the appropriate balance between promoting best evidence-based practice and acknowledging that evidence for rTMS use is a continually evolving. The guidelines provide up-to-date advice for psychiatrists and non-psychiatrists to promote optimal standards of rTMS practice.

Establishing an Integrative Oncology Service: Essential Aspects of Program Development.

Over the last 2 decades, integrative oncology (IO) has seen exponential growth within cancer care. It aims to combine evidence-based complementary therapies with conventional treatments to improve the well-being and quality of life for individuals dealing with cancer. The proliferation of integrative medicine programs in major cancer centers globally reflects varying approaches shaped by cultural, demographic, and resource-based factors. Drawing upon the expertise of leaders in IO from the Society for Integrative Oncology (SIO) Clinical Practice Committee, this manuscript serves as a practical guide for establishing an IO practice. Collating insights from diverse professionals, including oncologists, integrative oncologists, supportive care physicians, researchers, and clinicians, the paper aims to provide a comprehensive roadmap for initiating and advancing IO services. The primary objective is to bridge the gap between conventional cancer care and complementary therapies, fostering a patient-centric approach to address the multifaceted challenges encountered by individuals with cancer. This paper delineates several key sections elucidating different aspects of IO practice. It delves into the core components necessary for an IO service's foundation, outlines the initial medical consultation process, and presents crucial tools essential for successful consultations. By consolidating insights and expertise, this manuscript seeks to facilitate the integration of IO into mainstream cancer care, ultimately enhancing patient outcomes and experiences.

Linguistic Trends in Doctor-Patient Communication

Effective communication between doctors and patients is vital for successful consultations. Language plays a key role in making the communication between the doctor and the patient effective. Discourse studies that study language at its micro, as well as at its macro level, provide valuable insights into medical consultations. The objective of the present study is to provide an overview of various linguistic trends that emerged over time to examine talk in doctor-patient consultations. Studies examining doctor-patient discourse have been grouped under Interaction Analysis system, Rhetorical Genre Studies, Conversation analysis, sociolinguistics, Pragmatics, Ethnography, and Systemic Functional Linguistics. It was observed that the linguistic trends that emerged in other contexts were rarely applied to Indian medical consultations. Therefore, there is a need to study Indian doctor-patient consultations using discourse frameworks to arrive at findings that may be used to promote effective communication between the participants.

학교 컨설턴트의 의사소통 역량 모델 개발: Schein의 과정 컨설팅을 중심으로

The competency of school consultants’ is one of the major factors for successful school consulting. Specifically, the communication competency of school consultants is emphasized as a core competency because it is critical for the principle and process of consulting. This study aims to define the competency of school consultants, with a specific focus on elucidating the educational communication competency based on Schein’s Process Consultation perspective.&#x0D; The competency of school consultants can be categorized into common competency and professional consulting competency as a consultant. The common competency of school consultants includes communication, interpersonal relationship, synthetic thinking, utilization of information resources and technology, and self-management competency. The consulting competency consists of field specialty on school field and school education, process specialty for consulting principles and methodologies, and consulting ethics meaning confidentiality, sincerity, and autonomy in consulting.&#x0D; The communication competency of school consultant is classified as common competency, and consists of general communication and educational communication competency which has been derived from Schein’s consultation principles. The general communication competency includes writing, speaking, reading, and listening ability for effective delivery and understanding of messages, and discussion and moderation ability for narrowing the gap of opinions.&#x0D; The educational communication competency is composed of sub-factors that identify the purpose and content of communication based on Schein's consulting principles: 1) awareness of the importance of forming mutually helpful relationships and communication, 2) presentness of communication based on consultee’s now-here, 3) accuracy of communication, 4) awareness of the intervention influence, 5) consultee's agency and learning, 6) giving the consultee time to understand the situation and context and to provide feedback, 7) timeliness that captures important opportunities to increase the effectiveness of the intervention, 8) confronting intervention that changes the perspective of the consultee facing a constrained situation, 9) recognizing negative reactions and errors consultant's intervention and using them as data for effective consulting, 10) acknowledging the consultant's own limitations and sharing problem situations with consultee.&#x0D; This study is significant in developing a school consultants’ competency model and, in particular, deriving education communication competency, by identifying the educational meaning of communication in overall school consulting focusing on problem solving and consultant learning, which are the goals of Schein’s Process Consultation. However, this study could not deal with the whole competency of school consultant and has focused on the education communication competency, therefore, the relationships and complementary aspects with general communication competency, other common competency, and consulting competency, were not fully revealed.

Lexicographical Landscape: An Investigation into Digital Tools, Preferences, Challenges and Usage Patterns among Pakistani Graduate ESL Learners

The present study explores the uses, preferences and challenges of ESL learners in using digital lexicographical tools in typical Pakistani context. As technologies continue to shape language learning, the importance of digital lexicographical tools has increased substantially. However, the specific preferences and challenges in using these tools by the ESL learners are less explored in Pakistani context. The researchers employed mixed method approach and floated a questionnaire among 200 ESL learners from public sector universities eliciting their preferences, challenges and frequency of use. Additionally, focus group discussions and individual interviews provide deeper insights into participant’s perspective. Findings of the study reveal that these ESL learners exhibit strong tendency in using digital lexicographical tools (DLTs) due to easy accessibility and convenience in use. Most popular DLTs include Google online dictionary, Oxford Dictionary, thesauruses and Merriam Webster (Mobile Apps). Nevertheless, the study identifies challenges faced by the participants, such as limited internet connectivity, Google advertisements that impede a successful and trouble-free consultation process, the terminology used to describe the difficult terms they seek is beyond their comprehension lack of teachers’ guidance in selecting appropriate tools. They have positive attitude towards digital lexicographical tools to help them enhance their lexical development and language knowledge. Through DLTs, they have experienced a sense of autonomy and independence in learning. Furthermore, the study proposed that there is a need to gain guidance from teacher to select an appropriate and suitable digital lexicographical tools and suggested digital lexicographical tools based on their level of understanding.

National emergency medical teleconsultation: A novel system applied during the COVID-19 pandemic in Taiwan.

Telemedicine can facilitate social distancing during an infectious disease pandemic and reduce the burden on health-care resources. Moreover, telemedicine can be utilized for medical care in remote island regions, in home health care, and during isolated major disasters such as regional earthquakes. However, the effectiveness of telemedicine for emergency consultation remains unclear. This study introduced and analyzed the national emergency medical teleconsultation (NEMTC) established in Taiwan in 2022 during the COVID-19 pandemic. In response to the COVID-19 pandemic, Taiwan's Centers for Disease Control established a temporary 24-h NEMTC contingency system. Patient information was collected from consultations through the NEMTC from April 28 to June 28, 2022. After successful consultation, physicians made recommendations for home observation, emergency department (ED) visit, or outpatient follow-up. ED visits were divided into two categories, namely self-transport and transport, by the emergency medical service system (EMSS). During the aforementioned period, 20,902 consultation requests were made through the NEMTC, and 11,804 consultations (56.5% of 20,902) were successful. Consultation success rates were significantly higher for those who had a consultation between 08:00 and 16:00, had a waiting time of less than 10 min, and were not aged between 18 and 45 years. Moreover, 8.2% of the analyzed patients were advised to visit the ED, and only 0.4% required ambulance transportation. Children and older individuals and patients with cardiovascular symptoms, shortness of breath, or neurological or abdominal symptoms had a significantly higher chance of being referred to the ED than did other individuals. The NEMTC response system can enhance the efficiency of the EMSS and can reduce the burden of patients with mild conditions overloading the EMSS and EDs. The NEMTC could serve as an effective rapid response system during future pandemics.

Trust and confidence in using telehealth in people with chronic kidney disease: A cross-sectional study

Consumer trust and confidence in telehealth is pivotal to successful service implementation and effective consultations. This cross-sectional study measured trust and confidence in telephone and video consultations and associated with experience in telehealth modalities among people with chronic kidney disease at a metropolitan hospital in Australia. Self-report data were collected using validated trust and confidence in telehealth scales and 5-point Likert responses. Non-parametric tests were used to compare trust and confidence in telephone and video consultations (Wilcoxon Matched Pairs) and associations with telehealth experience (Mann–Whitney). Of the 156 survey participants, 96.2% had used telephone consultations and 28.9% had used video. Overall trust and confidence in using telehealth were high. Confidence (range 1–5) in using telephone consultations (mean 3.75 ± 0.71) was significantly higher than video consultation (mean 3.64 ± 0.74), p = 0.039. Trust in telephone consultations (mean 3.93 ± 0.64) was significantly higher than in video consultations (mean 3.67 ± 0.66), p < 0.001. There was a significant association between experience with telephone consultations and reported levels of trust and confidence in telephone consultations. Experience with video was significantly related to trust in video consultations, but not confidence. Given the substantial difference in experience between telehealth modalities, trust and confidence may change as further exposure occurs.

Driblando a Covid-19: Desafios e dilemas de um empreendedor

Objective: to investigate the motivations, profile and skills of the individual who chooses to undertake; promote reflection about the entrepreneur's position in the face of a major crisis; and seek an answer to the question: Is digital influencer to be an entrepreneur? Methodology/Approach: teaching case. Main results: in the “teaching notes”, discussions are suggested on entrepreneurship itself, the use of the business model and the internationalization of small companies. Theoretical and methodological contributions: the structure of the case contributes methodologically to the dynamics in the classroom, constituting one more tool for learning the subject in question. Relevance/originality: the case is relevant because it shows the story of an entrepreneur (Breno) who, after realizing his dream and creating a promising business (a travel agency), as a result of a major crisis (Covid-19, lockdown and its impact on the travel industry, as well as the depression and feeling of impotence generated by it), needs to reinvent himself professionally (becoming a successful online consultant for entrepreneurs). With the end of the pandemic and the resumption of business, the impasse arises: Remain as a digital influencer or reactivate the old company (since tourism has grown again)? Social contributions to management: the case shows the reality of the entrepreneur in Brazil and raises questions about the regulation of the digital influencer profession.

"We're trained to trust our patients": a qualitative study on the general practitioners' trust in patients for colorectal cancer shared care.

In a therapeutic partnership, physicians rely on patients to describe their health conditions, join in shared decision-making, and engage with supported self-management activities. In shared care, the patient, primary care, and specialist services partner together using agreed processes and outputs for the patient to be placed at the centre of their care. However, few empirical studies have explored physicians' trust in patients and its implications for shared care models. To explore trust in patients amongst general practitioners (GPs), and the impacts of trust on GPs' willingness to engage in new models of care, such as colorectal cancer shared care. GP participants were recruited through professional networks for semi-structured interviews. Transcripts were integrity checked, coded inductively, and themes developed iteratively. Twenty-five interviews were analysed. Some GPs view trust as a responsibility of the physician and have a high propensity for trusting patients. For other GPs, trust in patients is developed over successive consultations based on patient characteristics such as honesty, reliability, and proactivity in self-care. GPs were more willing to engage in colorectal cancer shared care with patients with whom they have a developed, trusting relationship. Trust plays a significant role in the patient's access to shared care. The implementation of shared care should consider the relational dynamics between the patient and health care providers.

Successful Electronic Consultation Service Initiative in Quebec, Canada With Primary Care Physicians' and Specialists' Experiences on Acceptance and Use of Technological Innovation: Cross-Sectional Exploratory Study.

Electronic consultation (eConsult) is an eHealth service that allows primary care providers (PCPs) to electronically consult specialists regarding their patients' medical issues. Many studies have demonstrated that eConsult services improve timely access to specialist care; prevent unnecessary referrals; improve PCPs', specialists', and patients' satisfaction; and therefore have a large impact on costs. However, no studies have evaluated PCPs' and specialists' acceptance of eConsult services in Quebec, Canada, and worldwide. This exploratory study aims to identify factors affecting eConsult service acceptance by PCPs and specialists in urban and rural primary care clinics across 3 regions in the province of Quebec, Canada, by integrating the Unified Theory of Acceptance and Use of Technology and Task-Technology Fit (TTF) models and user satisfaction. This research was designed to broaden and assist in scaling up this effective eHealth service innovation across the province. A cross-sectional web-based survey was sent to all PCPs (n=263) and specialists (n=62) who used the eConsult Quebec Service between July 2017 and May 2021. We proposed a unified model integrating the Unified Theory of Acceptance and Use of Technology model and TTF model and user satisfaction by endorsing 11 hypotheses. The partial least squares was used to investigate factors influencing the acceptance of the eConsult Quebec Service. Of the 325 end users, 136 (41.8%) users responded (PCPs: 101/263, 38.4%; specialists: 35/62, 57%). The results of the analysis with partial least squares method indicate that 9 of our 11 hypotheses are supported. The direct relationships uniting the various constructs of the model highlighted the importance of several key constructs and predominant correlations. The results suggest that satisfaction is the key driver behind the use of the eConsult Quebec Service. Performance expectancy (P<.001) and effort expectancy (P=.03) can have a positive impact on behavioral intention (BI), and BI (P<.001) can impact adoption. TTF has an influence on performance expectancy (P<.001), adoption (P=.02), and satisfaction (P<.001). However, the results show that there is no direct effect between social influence (P=.38) and BI or between facilitating conditions (P=.17) and adoption. This study provides a better understanding of the factors influencing PCPs' and specialists' intention to adopt the eConsult Quebec Service. Furthermore, this study tests a research model and a technology that have never been explored in Quebec until now. On the basis of the results, the service is a good fit to meet the users' need to improve access to specialized medical advice. Therefore, the results of our study have made a valuable contribution to the implementation of the service by policy makers in order to maximize acceptance, use, adoption, and success across the province of Quebec. Moreover, after 4 successful years, the eConsult Quebec pilot project is now the Conseil Numérique digital consultation service.

The Scalpel and the Ledger: Finance, Medicine and the Making of a Professional Life in Ireland, India and Britain, 1888–1921

By the time of his death in September 1921, Peter Johnstone Freyer was an extremely wealthy man. After an education at Queen's College Galway, his medical career had been defined by colonial service in India, and the establishment of a successful surgery and consultancy on London's Harley Street. In public, these hallmarks of his career led to him being described by his contemporaries as amongst medicine's most prominent figures, and as a ‘great surgeon’ by newspapers the length of and breadth of the United Kingdom on the occasion of his death. However, his private papers show that his medical practice was only responsible for a small part of his material success; two-thirds of his wealth was derived from his skill, exercised in private, as an investor in financial markets. By establishing his history as an investor, and comparing it to his public profile in medicine, this article traces the social and cultural histories of professional identity in late-Victorian and Edwardian London. Over the course of its arc, it demonstrates how medicine's public significance in this period was part of a broader, middle-class, professional culture concerned with the accrual of ‘virtual’ wealth, the construction of advantageous social networks, and the tapping of capital in multiple forms. In sum, Freyer's career reflects the symbolic meaning of publicly wielding a scalpel, whilst privately managing a portfolio of financial ledgers.

The Significance of Physician-Patient Communication on Telemedicine Patients’ Health Outcomes: Evidence from Indonesia

ABSTRACT The importance of physician-patient communication on patient health outcomes has been globally known. Poor communication in clinical settings, including in telemedicine visits, has been identified as a key barrier to successful medical consultation. This barrier is even more prevalent among people from linguistically and culturally diverse communities. This study investigated the influence of physician-patient communication on telemedicine patient health outcomes in Indonesia, a developing country with great linguistic and cultural diversity. This study utilized secondary data from a telemedicine utilization survey conducted during the coronavirus disease 2019 (COVID-19) pandemic. Socioeconomic factors and communication features were included as predictors of patients’ health improvement. Logistic regressions were utilized to examine the significance of the communication features on patients’ health. The analysis results indicated that five communication features including the adequacy of consultation length, a timely physician response, the provision of an explanation of the medication and possible side effects, the patient’s ability to utter their physical condition and opinion regarding medication goals, and the patient’s ability to comprehend physician explanations and instructions were significantly associated with the patient’s health outcomes. Physicians and healthcare providers should focus on the provision of communication features revealed in this study to elevate the likelihood of improved health conditions in telemedicine patients.

Experiences with the quality of telemedical care in an offshore setting – a qualitative study

BackgroundThe evaluation and the improvement of the quality of telemedical care become increasingly important in times where this type of care is offered to a broad number of patients more and more. As telemedical care in an offshore setting has already been in use for decades, analyzing the extensive experience of offshore paramedics using telemedical care can help identify determinants of quality. Therefore, the aim of this study was to explore determinants of the quality of telemedical care using the experiences of experienced offshore paramedics.MethodsWe conducted a qualitative analysis of 22 semi-structured interviews with experienced offshore paramedics. The results were categorized in a hierarchical category system using content analysis as described by Mayring.ResultsAll 22 participants were males, having a mean of 3.9 years of experience working with telemedicine support offshore. Generally, participants stated that for them telemedical interaction did not differ much from personal interaction. However, the offshore paramedics personality and way to communicate were mentioned to impact the quality of telemedical care as it influenced the way cases were presented. Furthermore, interviewees described it to be impossible to use telemedicine in cases of an emergency as it was too time-consuming, technically too complex, and lead to cognitive overload as other tasks with higher priority needed their attention. Three determinants of a successful consultation were mentioned: low levels of complexity in the reason for consultation, telemedical guidance training for the teleconsultant physician and for the delegatee.ConclusionAppropriate indications for telemedical consultation, communication training of consultation partners, and the impact of personality need to be addressed to enhance the quality of future telemedical care.

Ankle Telemedicine Planning Considerations.

A virtual medical visit, also known as telemedicine or telehealth, is a valuable alternative method of providing health care to patients who do not have easy access to a hospital, or during times when limited social interaction is crucial such as our current COVID-19 pandemic. A virtual approach to evaluating musculoskeletal system ailments is particularly challenging, for diagnosis of these conditions generally rely greatly on physical examination, which may be challenging. However, a properly planned and executed telemedicine visit will yield successful results in most cases. Our aim is to produce a document with instructions and suggestions, including physical examination maneuvers, to help physicians carry out a proper virtual medical visit with patients complaining of ankle musculoskeletal problems. Virtual visits should not be thought of as a replacement for traditional face-to-face medical consultations, but rather a complementary method to provide health care when deemed appropriate. By following this guide, and tailoring it to the specific case at hand, medical providers should be able to effectively carry out a successful telemedicine consultation for musculoskeletal ailments relating to the ankle.Levels of Evidence: Level V.

Elucidating the Elements of Clinical Case Consultation in Cognitive Processing Therapy

Research shows the value of consultation following training in Cognitive Processing Therapy (CPT), a frontline psychotherapy for posttraumatic stress disorder; however, the elements of successful CPT consultation are not delineated. This study’s aim was to elucidate the elements of successful consultation in CPT. Participants ( N = 41) were mental health clinicians, including psychologists, social workers, nurses, and psychiatrists, and consultants ( N = 4), who provided clinical case consultation. The clinicians participated in group clinical case consultation for 6 months following their workshop participation. Thirty audio recorded consultation calls were analyzed using thematic analysis. Elements were identified and organized according to the following themes: Organization, Knowledge Consolidation, Case Conceptualization, Directive Instruction, Nondirective Instruction, and Provision of Feedback. Important next steps include: (a) developing a model positing how the elements of successful clinical case consultation in CPT fit together and (b) identifying its mechanisms.