Medical training

Saba et al. (2014) ^{Reference Saba, Chou and Satterfield16} studied and assessed the outcomes of a specific model of phone communication training within healthcare, implementing a ‘Telephone Follow-up Curriculum’ which encouraged students’ patient-centred skills. Students and faculty both reported improvement in students’ understanding of, and attitudes towards telephone follow-up. The majority of students agreed or strongly agreed that they learned about patient health behaviours (77%), that their ability to provide patient education improved (71%), and that these communication skills will be relevant to future patient encounters (94%). ^{Reference Saba, Chou and Satterfield16} More recently, Seale et al. (2019) ^{Reference Seale, Ragbourne and Purkiss Bejarano15} conducted a study with 50 undergraduate medical students where half of the students undertook specific telephone training (combination of 1 h session including PowerPoint and a practical component) followed by a short simulation session 7–14 days later. All 25 students felt positive about the learning experience and felt they would use aspects of the training in their role as junior doctors. Compared to the untrained group, students felt more confident and prioritised their job list in alignment with the clinical skills team. ^{Reference Seale, Ragbourne and Purkiss Bejarano15} However, some gaps were still identified in the trained group and the authors concluded that more extensive education and practise of these skills was required. All students agreed that this specific telephone teaching was an important component and should be added as a standard within medical programmes. ^{Reference Seale, Ragbourne and Purkiss Bejarano15}

Hindman et al. (2020), ^{Reference Hindman, Kochis and Apfel17} using a convenience sample of third-year medical students, divided students into a control and intervention group where the intervention involved teaching of specific telephone medicine curriculum. Students in the intervention group had a significantly higher mean score on a simulated Objective Structured Clinical Examination (OSCE) compared to the control group. Jonas et al. ^{Reference Jonas, Durning, Zebrowski and Cimino18} also piloted a tailored telehealth curriculum for 149 third-year medical students finding similar results. McDaniel et al. ^{Reference McDaniel, Molloy and Hindman19} developed telephone triage curriculum for their 3^rd and 4^th year medical students (74 students) where students self-reported that this teaching increased their knowledge (73%) and was engaging (86%). Other authors who have provided evidence-based models for integration of telehealth curriculum into their medical programmes include Pathipati et al., ^{Reference Pathipati, Azad and Jethwani20} Rienits et al., ^{Reference Rienits, Teuss and Bonney21} Vasquez-Cevallos ^{Reference Vasquez-Cevallos, Bobokova, Bautista-Valarezo, Dávalos-Batallas and Hernando22} and Walker et al. ^{Reference Walker, Echternacht and Brophy23}

Omoruyi et al. (2018) ^{Reference Omoruyi, Dunkle, Dendy, McHugh and Barratt24} explored the challenges of telecommunication for patients requiring interpretation due to language barriers and stressed the need for educational interventions, which consider this aspect of patient care. They specifically looked at the impact of introducing a 1-hour interactive educational intervention to medical students regarding issues related to live versus remote interpreter management. Utilising control and intervention cohorts, they reviewed students’ telephone interpreter skills using actual patient encounters post-intervention. In comparison to the control groups, the intervention group felt more competent, provided clearer information at the optimal pace and excelled in closing out conversations appropriately.

Veterinary training

Sheats et al. ^{Reference Sheats, Hammond and Kedrowicz25} who analysed 25 phone calls of final year veterinary students, also identified gaps in their telephone communication, concluding that specific education is needed to improve case review, preparation in addressing questions or concerns, following of organisational protocols along with listening and reflection skills related to demonstration of empathy. Grevemeyer et al. ^{Reference Grevemeyer, Betance and Artemiou26} stress the importance of specific telephone training for veterinary students and discuss their programme which incorporates the Calgary–Cambridge Guide (CCG) as a conceptual framework for this tailored communication skills training which includes practically simulated telephone communication.

Nurse training

Chike-Harris ^{Reference Chike-Harris27} discusses the integration of telehealth into a nursing programme curriculum using eight competencies provided by the National Organisation of Nurse Practitioner Faculties for telehealth education. Telehealth curriculum including didactic and simulated learning was integrated into all years of the nursing programme. Student pre-test/post-tests scores increased significantly and the feedback from students was very positive. The potential requirement for early education in this area of practice was evidenced by Glinkowski et al. ^{Reference Glinkowski, Pawłowska and Kozłowska28} who found, through surveying nursing students, that only the final year students believed telenursing may improve nursing practice, years 1 and 2 students may require further education regarding the benefits. Lister et al. (2018) ^{Reference Lister, Vaughn, Brennan-Cook, Molloy, Kuszajewski and Shaw29} and List et al. (2019) ^{Reference List, Saxon, Lehman, Frank and Toole30} through modifying their nursing curriculum to include telehealth, demonstrated that even small modifications to the existing curriculum can improve student confidence in this aspect of their practice. Other nursing programmes incorporating telehealth simulation have also demonstrated improvement knowledge gain through this adaptation of curriculum ^{Reference Mennenga, Johansen, Foerster and Tschetter31} . Rutledge et al., ^{Reference Rutledge, Kott, Schweickert, Poston, Fowler and Haney6} based on their experience, outline a range of comprehensive topics and techniques which they advocate including in telehealth nursing curriculum.

Allied health professional (AHP) training

Few studies in the narrative review included AHP-specific telephone skills training. Gustin et al. ^{Reference Gustin, Kott and Rutledge32} describe the implementation of online learning and simulated training within an interprofessional module including advanced practice nurses, graduate health professionals and undergraduate dental hygiene students (103 participants). This intervention demonstrated improvement in all aspects of knowledge and students scored higher in their simulation encounters post-intervention. However, it should be noted that this education focused more on video communication rather than telephone communication though arguably these skills would apply to both scenarios. Gustin et al. ^{Reference Gustin, Kott and Rutledge32} conclude that, based on student comments and pre-intervention knowledge scores, there is a strong need for training in telehealth in all healthcare professions. The study supports the notion that telehealth etiquette is not intuitive and needs to be formally taught as part of all healthcare programmes. Randell et al. ^{Reference Randall, Steinheider and Isaacson33} also assessed a telehealth intervention as part of an interprofessional curriculum including occupational therapists, physiotherapists and student nurse practitioners. They concluded that the intervention resulted in increasingly positive perceptions regarding the use of telehealth for patient review though qualitative student data indicated that students perceived telehealth as ‘an added barrier to interacting with the patient and with other members of the team’ (p. 350). ^{Reference Randall, Steinheider and Isaacson33} Randell et al. also focused on video communication rather than telephone communication.

The narrative review demonstrates that while there may be a limited number of publications specifically addressing telephone skills training in allied health professions, including therapeutic radiography, there is a strong need for specific high-quality training in the area. While telehealth, including telephone skills training, is increasingly being integrated into healthcare programmes, ^{Reference Camhi, Herweck and Perone34} this appears to be mainly occurring in medical and nursing programmes. Publications reviewed consistently demonstrate that the development and integration of evidence-based telephone skills training, improves student confidence, awareness, knowledge and skills in this area of practice. ^{Reference Vaona, Pappas, Grewal, Ajaz, Majeed and Car4} Ideally the training might be incorporated into all years of undergraduate therapeutic radiography programmes ^{Reference Saba, Chou and Satterfield16} with a combination of multiple teaching modalities including didactic and simulated teaching. ^{Reference Vaona, Pappas, Grewal, Ajaz, Majeed and Car4,Reference Stovel, Gabarin, Cavalcanti and Abrams35} Simulated teaching ideally would involve the use of standardised patients and cover areas including the importance of ‘appearance, distractors, privacy, nonverbal and verbal communication and strategies to effectively express empathy’ (p. 89). ^{Reference Gustin, Kott and Rutledge32} This tailored learning may be ideally placed in interprofessional modules throughout the curriculum as all allied health professionals need to develop effective communication skills.

While the majority of studies focused on the student outcomes and demonstrated very positive findings, very few studies actually explored how the learning translated to the quality of patient experience. More research might be undertaken to assess current therapeutic radiography training with direct assessment of its impact on patient care. Moving forward, aptly chosen patient-reported outcome measures (PROMs) may prove useful to enable evaluation of long-term retention of skills and tangible benefits to patient quality of care. Few studies to date have captured the experiences of patients post-training and determined the true benefit of training to the patient experience and wellbeing.

There is an opportunity within telehealth to enhance access to care, quality of care and satisfaction for both patients and reviewers. ^{Reference Rodler, Apfelbeck and Schulz13} While health professionals routinely receive training in communication and reviewing skills, this does not necessarily include the specificities of telephone communication. Telephone reviews require the same degree of thoroughness and careful clinical judgment as face-to-face consultations. The standards of education and training for higher education programmes might be refreshed by the HCPC to ensure that student radiographers are achieving refreshed standards of proficiency in this dimension of communication. The student standards of proficiency might be evidenced through simulated practice moderated by experienced therapeutic radiographers. ^{Reference Chambers, Hickey, Borghini and McKeown36}

It is well established that therapeutic radiographers should be well prepared, engaged and courteous when undertaking reviews. They should be friendly and warm and not make patients feel rushed. ^{Reference Vidal-Alaball, Acosta-Roja and Pastor Hernández37} Asking open-ended questions, effective listening, appropriate praise, providing enough information as part of advice and finally checking the patient’s understanding, are all key areas of communication during a review. ^{Reference Shendurnikar and Thakkar10} Ultimately, therapeutic review radiographers may need further training in telehealth to enhance their communication skills and so make up for the lack of visual stimuli. ^{Reference Rothwell, Ellington, Planalp and Crouch38} Understanding the barriers that inhibit radiographer and patient communication can provide an opportunity to eliminate them. Radiographers need to acquire telehealth consultation skills in order to thrive in an increasingly pressurised health system that demands the delivery of high-quality, high-volume health care within the confines of a shrinking health care workforce. The distinct differences between telehealth and face-to-face consultations necessitate a need to provide guidelines and recommendations to educate both health professionals and patients on how they can best participate in telephone reviews. ^{Reference Vidal-Alaball, Acosta-Roja and Pastor Hernández37} The use of competency-based training for telephone reviews will facilitate high-quality, safe and effective consultations ^{Reference Lum, van Galen and Car39} especially if telehealth becomes the new post-COVID-19 normal.