International Journal of Healthcare Simulation

Background:

Effective communication in the healthcare setting is essential for safe clinical practice and providing good patient care. Doctors frequently request and receive clinical tasks and information over the telephone, a skill which became even more important during the COVID-19 pandemic [1]. However, these skills are rarely incorporated into the medical school curriculum and new Foundation Year 1 (FY1) doctors lack the confidence and ability to effectively communicate over the telephone [2]. The aim of this project was to improve the confidence of medical students in communicating over the telephone in a clinical context using scenarios.

Methods:

A team of post-foundation doctors created seven telephone-based scenarios representative of what a FY1 doctor could commonly experience on a ward. Each patient scenario involved two telephone calls to healthcare professionals (e.g.: doctors, nurses, pharmacists, allied health professionals) and/or patient relatives who were role-played by clinical teaching fellows (CTFs). Tasks included making requests and referrals, taking collateral histories, asking for specialist advice, and updating the next of kin. Students entered the simulation suite individually and received a short verbal handover along with patient notes, then used their clinical judgement to decide who to call. The remaining students observed the live video stream with audio from a different room and also had access to the patient notes and results. A tutorial was given before the simulation session on confidentiality, how to use a hospital telephone, and how to use the ‘Situation, Background, Assessment, Recommendation’ (SBAR) referral tool. All students completed questionnaires before and after the simulation and confidence was measured on a 10-point Likert scale. Student-led debriefings after each scenario were facilitated by CTFs.

Results:

A total of twenty-two fourth-year medical students participated. 73% had never received any formal teaching on telephone communication. 40% had never used the telephone during their clinical placements. 41% were not aware of the SBAR tool prior to the session. The questionnaire results from pre-simulation (M=4.24, SD=1.30) and post-simulation (M=6.57, SD=1.47) indicate that there was a statistically significant increase of students’ confidence in communicating over the telephone, t(22)=4.1, p<0.001. Free-text feedback demonstrated an improved understanding of the most appropriate person to call in different situations.

Conclusion:

Our results demonstrate the benefit of simulation in increasing the confidence of medical students in telephone communication. Formally incorporating this training into medical school curriculums may improve patient care involving FY1 doctors and ensure safer communication in clinical practice.

References

1. Schrager SB. Managing a Telephone Encounter: Five Tips for Effective Communication. Fam Pract Manag. 2020;27(3):4.

2. Marshall SD, Harrison JC, Flanagan B. Telephone referral education, and evidence of retention and transfer after six-months. BMC Medical Education. 2012;12(1):38.