Telephone referral education, and evidence of retention and transfer after six-months

Abstract

BackgroundEffective communication between clinicians is essential for safe, efficient healthcare. We undertook a study to determine the longer-term effectiveness of an education session employing a structured method to teach referral-making skills to medical students.MethodsAll final year medical students received a forty-five minute education intervention consisting: discussion of effective telephone referrals; video viewing and critique; explanation, demonstration and practice using ISBAR; provision of a memory aid for use in their clinical work. Audio recordings were taken during a subsequent standardised simulation scenario and blindly assessed using a validated scoring system. Recordings were taken immediately before (control), several hours after (intervention), and at approximately six months after the education. Retention of the acronym and self-reports of transfer to the clinical environment were measured with a questionnaire at eight months.ResultsReferral clarity at six months was significantly improved from pre-intervention, and referral content showed a trend towards improvement. Both measures were lower than the immediate post-education test. The ISBAR acronym was remembered by 59.4% (n = 95/160) and used by the vast majority of the respondents who had made a clinical telephone referral (n = 135/143; 94.4%).ConclusionsA brief education session improved telephone communication in a simulated environment above baseline for over six months, achieved functional retention of the acronym over a seven to eight month period and resulted in self reports of transfer of the learning into practice.

How can we improve teaching of ECG interpretation skills? Findings from a prospective randomised trial

“…In one study, students taking a retention test six weeks after receiving simulator training on the clinical management of chest pain and shortness of breath scored between 70% and 80% of the points they had achieved in a post-training directly after teaching [18]. Similarly, six-month retention rates of 64% have been reported for telephone referral skills [19]. In our study, proportional retention at two months ranged from 70% (any teaching followed by a summative assessment) to 83% (any teaching followed by a formative assessment).…”

Tools for structured team communication in pre-registration health professions education: a Best Evidence Medical Education (BEME) review: BEME Guide No. 41

“…These included the cognitive, affective and psychomotor aspects of learning, experiential, adult and collaborative learning theories and mastery learning (data not shown). Active learning, with the opportunity to practise, share personal experiences and reflect on performance was thought to contribute to the success of a telephone referral intervention (Marshall et al, 2012).…”

“…Tool-specific evaluations provided some evidence that tools for structured communication can improve students' ability to give clear and comprehensive messages and/or to receive and understand information. The clarity and content of telephone referrals made by final year medical students significantly improved following training in the use of ISBAR (identify, Situation, Background, Assessment, Request) compared with a control group and much of this improvement was still apparent six months later (Marshall et al, 2009;Marshall et al, 2012); and medical students attending surgical morbidity and mortality conferences demonstrated significantly improved understanding of patient safety issues when presenters were required to use an adapted SBAR format to structure their presentations (Mitchell et al, 2013). Whole intervention evaluations reported similar benefits: medical students' communication skills were significantly improved following a surgical simulation curriculum based on the 'TeamSTEPPS® Essentials' course, which included the use of SBAR and the 'two-challenge' rule (Meier et al, 2012); and the use of ISOBAR in an interprofessional training ward facilitated communication at handover (Brewer & Stewart-Wynne, 2013).…”

“…Finally, tool-specific evaluations provide evidence that students intend to transfer their learning to their clinical work (Aebersold et al, 2013;Darcy Mahoney et al, 2013) and that, in some cases at least, they are able to do so several months after an educational intervention on the use of SBAR in telephone referrals; over 90% of the medical student participants reported that they had actually used SBAR whilst on placement (Marshall et al, 2012).…”

Teaching and developing referral skills for new doctors

“…The seminar included: exploration of experiences to date (positive and negative); discussion of what constitutes a good referral; structural tools for referral (e.g. the ISBAR tool); two fictitious scenarios to illustrate preparation, information gathering, logical structure, clear aims and focusing on pertinent aspects; and two role‐play scenarios.…”