Teaching referral skills to medical students.

BACKGROUND: Referrals are an important and frequent part of a junior doctor's work. Difficulty with making successful referrals is also very common. Despite this, training in referral skills is not routinely carried out in medical schools. RESULTS: We designed and delivered a 1-h interactive lecture to final year medical students to teach referral skills. The lecture was delivered on six occasions to up to 70 students at each session. 191 students attended and provided evaluation. 68% of students had no previous training in referral skills and 99% felt that referral skills should be included in the undergraduate curriculum. 90% reported that the lecture had improved their understanding of referral techniques and 83 and 80% felt that the lecture had improved their ability and confidence, respectively. CONCLUSIONS: Referral skills can be successfully taught in a large group lecture setting. We recommend that the teaching of referral skills is incorporated into all medical schools' curricula.

Sticks and stones: investigating rude, dismissive and aggressive communication between doctors.

Destructive communication is a problem within the NHS; however previous research has focused on bullying. Rude, dismissive and aggressive (RDA) communication between doctors is a more widespread problem and underinvestigated. We conducted a mixed method study combining a survey and focus groups to describe the extent of RDA communication between doctors, its context and subsequent impact. In total, 606 doctors were surveyed across three teaching hospitals in England. Two structured focus groups were held with doctors at one teaching hospital. 31% of doctors described being subject to RDA communication multiple times per week or more often, with junior and registrar doctors affected twice as often as consultants. Rudeness was more commonly experienced from specific specialties: radiology, general surgery, neurosurgery and cardiology. 40% of respondents described that RDA moderately or severely affected their working day. The context for RDA communication was described in five themes: workload, lack of support, patient safety, hierarchy and culture. Impact of RDA communication was described as personal, including emotional distress and substance abuse, and professional, including demotivation. RDA communication between doctors is a widespread and damaging behaviour, occurring in contexts common in healthcare. Recognition of the impact on doctors and potentially patients is key to change.