Over the last several years we have seen the rapid growth of the specialty of hospital medicine across the country. One of the unintended consequences of this expansion has been the decrease in direct teaching responsibilities of the medical subspecialists on the inpatient medical teaching services. As these responsibilities have been subsumed by our hospitalists, our trainees and students unfortunately have a more limited exposure to our medical subspecialty faculty.


To address the reduction in medical subspecialty teaching of our trainees, the VA New York Harbor Healthcare System-New York Campus, part of the NYU Langone Medical Center Internal Medicine Residency Program has begun an educational program we call OpenConsult.


OpenConsult takes its name from a popular online restaurant reservation system.  Trainees make educational “reservations” with the on-service consult subspecialty attendings for 30-minute teaching sessions. Using an online calendar with specified times and locations, the trainees indicate the patient and relevant topic they wish to discuss. Teams of residents and students are expected to place up to 3 reservations each week. Currently, we are offering sessions in Cardiology, Gastroenterology, Hematology, Infectious Disease, Nephrology, Oncology and Pulmonary. We have also recently expanded the reservation system to include our VA Simulation Center faculty, so trainees can review actual medical rapid response and code events in a protected environment. Shortly, we will be expanding OpenConsult offerings, to include Endocrine, Rheumatology, Ethics and Palliative Care. 


The feedback from our trainees and faculty about this innovative learner directed model of teaching has been uniformly outstanding. Trainees and students are receiving increased access to and interaction with our specialty faculty.  They are learning about the nuances of their patients’ diseases at the subspecialty level. Moreover, the specialists participating in OpenConsult are the consult attendings that are on-service. So instead of “drive-by” teaching from a specialist not involved in the case, the trainees get to discuss the clinical reasoning for the actual decisions being made. Thus, both parties have a vested interest in exploring the case in detail. These sessions then become more powerful, relevant and ultimately memorable for our trainees and students. Based on the success of this model, we will soon be expanding OpenConsult to our two other affiliate sites. OpenConsult has brought together our faculty, trainees and students in an innovative way to collaborate and learn together while ensuring that excellent communication is occurring.