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Open Access Open Badges Research article

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

Stuart D Marshall123*, Julia C Harrison4 and Brendan Flanagan24

Author Affiliations

1 Southern Health Simulation Centre, Monash Medical Centre Moorabbin Campus, Centre Road, East Bentleigh, Melbourne, Australia

2 Monash University, Academic Board of Perioperative Medicine, Commercial Road, Prahran, Melbourne, Australia

3 University of Queensland, Cognitive Engineering Research Group, St Lucia, Brisbane, Australia

4 Monash University, Central Clinical School, Commercial Road, Prahran, Melbourne, Australia

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BMC Medical Education 2012, 12:38  doi:10.1186/1472-6920-12-38

Published: 7 June 2012



Effective 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.


All 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.


Referral 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% (nā€‰=ā€‰95/160) and used by the vast majority of the respondents who had made a clinical telephone referral (nā€‰=ā€‰135/143; 94.4%).


A 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.