Learning to be a consultant: what should be taught.

consultant: " a hospital doctor of the highest rank who is an expert in a particular area of medicine " 1 As noted in earlier articles and editorials in this series on education and training in pathology and laboratory Medicine, 2-6 we look more and more for evidence as to what should be taught, how it should be taught, and when it should be taught. Education and training are entering a new era that is driven by better research, careful analysis of research findings , and new approaches for applying those findings. One of the most important parts of this new approach is the issue of what should be taught. Although it may seem obvious that students and trainees should be taught what they need to know to advance in the next stages of their careers, most content has been focused on preparing students and trainees to complete their education or training; there has been much less emphasis on career development. More recently, resident training has seen a major shift towards standardization , primarily through efforts of the Accreditation Council for Graduate Medical Education (ACGME) and individual residency review committees for each medical specialty. But many gaps remain: the long-lamented lack of education and training in the business aspects of health care, formal training in informatics, and so forth. A less obvious gap that only recently is being addressed is the idea of the training needed to enable individuals to make the transitions that occur as a natural part of careers. One of those is the subtle transition for becoming an expert consultant. Consultation is one of the most challenging and rewarding activities of physicians. Consultants by definition provide expertise and services beyond what general practitioners provide. As a result, there are higher expectations for consultants and for the expertise that they provide. Not surprisingly, most consulting activities require expertise and experience available from attending physicians: junior trainees simply do not possess the knowledge, skills, or experience to provide adequate consultative services. One might fairly ask how does one know when a trainee or junior attending has attained those attributes that are necessary for effective consultation? How are the necessary skills taught? At what point in training should they be taught? And perhaps, most importantly, what should be taught? There is no simple answer to the first question. To date, we have no objective way to assess the career development …