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

<b>Introduction:</b> Calls for the inclusion of standardized protocols for information exchange into pre-registration health professions curricula have accompanied their introduction into clinical practice. In order to help clinical educators respond to these calls, we have reviewed educational interventions for pre-registration students that incorporate one or more of these ?tools for structured communication?. <b>Methods:</b> Searches of 10 databases (1990?2014) were supplemented by hand searches and by citation searches (to January 2015). Studies evaluating an intervention for pre-registration students of any clinical profession and incorporating at least one tool were included. Quality of included studies was assessed using a checklist of 11 indicators and a narrative synthesis of findings undertaken. <b>Results:</b> Fifty studies met our inclusion criteria. Of these, 21 evaluated the specific effect of a tool on educational outcomes, and 27 met seven or more quality indicators. <b>Conclusions:</b> 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; mostly ‘Situation Background Assessment Recommendation’ and its variants. There is some evidence that learning to use a tool can improve the clarity and comprehensiveness of student communication, their perceived self-confidence and their sense of preparedness for clinical practice. There is, as yet, little evidence for 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.

**引言：** 将信息交换标准化方案纳入注册前卫生专业课程的呼吁，伴随着此类方案在临床实践中的推广应用而日益高涨。为助力临床教育工作者响应此类呼吁，我们针对纳入了一种或多种结构化沟通工具（tools for structured communication）的注册前学生教育干预方案开展了系统综述。
**研究方法：** 我们对10个数据库（检索时限为1990年至2014年）进行了系统检索，并辅以手工检索与引文检索（检索截至2015年1月）。纳入所有针对任意临床专业注册前学生、且至少纳入一种结构化沟通工具的教育干预效果评估研究。采用包含11项指标的核查清单对纳入研究的质量进行评估，并对研究结果开展叙述性综合分析。
**研究结果：** 共计50项研究符合本研究的纳入标准。其中21项研究评估了结构化沟通工具对教育结局的具体影响，另有27项研究满足至少7项质量指标要求。
**研究结论：** 注册前卫生专业学生（尤其是美国的学生）正通过专项课程或融入更广泛的课程体系，学习使用结构化沟通工具，其中以「情境-背景-评估-建议（Situation Background Assessment Recommendation）」及其变体最为常见。现有部分证据表明，学习使用结构化沟通工具可提升学生沟通的清晰度与全面性，增强其自我感知的自信心，以及其临床实践准备的充足感。但目前尚无充分证据表明此类技能可迁移至临床场景，也未发现教学方法对学习结局存在显著影响。教育工作者需考量此类技能学习与临床推理、临床决策等其他技能的整合定位。