Describing the "Learning Loop": An overall structural organization of SCAN-ECHO video consultations between specialist and generalist providers for specialty care liver problems

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Consultations are the traditional method of communication between generalists and specialists managing patients with specialty care needs. Videoconferencing health information technology enables generalist and specialist providers to co-manage patients with complex chronic illness and can facilitate workplace learning about specialty care. This study analyzes 32 video consultations between generalist and specialist providers caring for patients with chronic liver disease at two U.S. sites to describe the overall organizational features and constituent interactional activities. Results show that video consultations have a four phase overall structure and three distinct consultation types: full cases in which gener-alists presented new patient cases; updates in which generalists or specialists revisited previously discussed cases; and summaries in which specialists presented new cases. Results suggest that providers take-for-granted the learning opportunities available in each consultation type. Increased awareness of the overall organization and interactional activities help providers diversify specialty care learning opportunities and, ultimately, improve health outcomes.