Effective communication is a cornerstone of patient safety. Communication failures are consistently identified as a contributing factor in patient safety incidents, serious incidents, and complaints. The panel will assess your communication skills throughout the entire interview, but they may also ask specific questions about how you communicate in high-pressure situations.
SBAR for Clinical Handovers and Escalation
SBAR (Situation, Background, Assessment, Recommendation) was covered in Module 1 as a framework. In this lesson, we go deeper into its practical application. SBAR is endorsed by NHS England and the World Health Organisation (WHO) as a standardised communication tool for clinical handovers. It is particularly important when: escalating a deteriorating patient to a registrar or consultant (especially by phone, where you cannot use visual cues), handing over patients at shift changes (ensuring continuity of care), referring a patient to another specialty (making an efficient, structured referral), and communicating with the critical care outreach or crash team during an emergency.
Closed-Loop Communication in Emergencies
During emergency situations (e.g., cardiac arrest, major haemorrhage, trauma calls), closed-loop communication is the gold standard. This means: the team leader gives a clear instruction directed at a specific person (“Dr [Name], please give 1mg adrenaline IV now”), the team member repeats the instruction back (“Giving 1mg adrenaline IV now”), and the team member confirms completion (“1mg adrenaline IV given”). This three-step process prevents errors from miscommunication, ensures instructions are heard and understood, and provides confirmation that the task has been completed. If you have ALS (Advanced Life Support) certification from the UK Resuscitation Council, you will have practised closed-loop communication during your course — reference this.
Communicating with Relatives Under Pressure
The panel may ask how you would communicate with a distressed relative, deliver bad news, or manage a situation where a family member is demanding information. Key principles: find a private space, sit down, introduce yourself, use plain language (avoid medical jargon), check understanding by asking the relative to summarise what you have said, allow silence and emotional responses, and offer clear follow-up (“I will arrange for the consultant to speak with you tomorrow at 10am”). Reference the SPIKES framework (from Module 5) for breaking bad news, and be aware of confidentiality considerations — you need the patient’s consent before sharing clinical information with relatives, unless the patient lacks capacity.
Cross-Specialty Referrals
Making effective referrals to other specialties is a daily task for junior doctors and is sometimes tested in interviews. Use SBAR when making referrals. Be prepared with: the patient’s name, date of birth, and location; a concise summary of the clinical problem; relevant investigation results; what you have already done; and a specific question or request (“I am requesting an urgent surgical review for this patient who I believe has peritonitis”, not “Could you come and have a look at this patient?”). A clear, structured referral saves time and ensures the patient receives timely care.