Tools for structured team communication in pre-registration health professions education: a Best Evidence Medical Education (BEME) review

Standardised protocols for information exchange between health professionals, such as Situation Background Assessment Recommendation (SBAR), are being introduced into clinical practice. Often described as ‘tools for structured communication’, introduction of these protocols is, in part, the result of efforts to apply good practice from aviation safety to health care.
Calls for trainee health professionals to understand and be able to use such tools when they enter clinical practice have accompanied these developments. In order to help clinical educators to decide how best to respond to these calls, we have reviewed the educational literature reporting the integration of one or more tools for structured communication into an educational intervention for pre-registration health professions students.

Searches of 10 databases (1990-2014) were supplemented by hand searches and by citation searches (to January 2015). Studies involving pre-registration students from any clinically focussed profession and reporting evaluation of an intervention incorporating one or more tools were included. We assessed the methodological quality of included studies using a generic checklist of 11 indicators and undertook a narrative synthesis of study findings. Fifty studies met our inclusion criteria, of which just over half met seven or more quality indicators. In 21 studies (42%), evaluations considered the specific effect of a tool on educational outcomes. The remainder evaluated the whole intervention, of which the tool(s) were a part.

Our review indicates that pre-registration students, particularly those in the US, are learning to use tools for structured communication, either in specific sessions or integrated into more extensive courses or programmes; and that they are mostly learning to use SBAR and its variants. Interventions are mostly for uni-professional groups and often use simulation. There is some evidence that learning to use one or more tools can improve the clarity and comprehensiveness of student communications, their perceived self-confidence and their sense of preparedness for clinical practice. However, there is as yet little evidence relating to the transfer of these skills to the clinical setting or for any influence of teaching approach on learning outcomes. Educators will need to consider the positioning of such learning with other skills such as clinical reasoning and decision-making.