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Original article

Vol. 144 No. 1314 (2014)

Consequences of insecurity in emergency telephone consultations: an experimental study in medical students

  • Jürgen Barth
  • Regina Ahrens
  • Mireille Schaufelberger
Cite this as:
Swiss Med Wkly. 2014;144:w13919


QUESTION UNDER STUDY: Handling emergency telephone consultations (ETCs) is a challenging and very important task for doctors. The aims of the study were to document insecurity in medical students during ETCs and to identify the reasons for that insecurity. We hypothesised that insecurity is associated with advising more urgent action (e.g. advice to call for an ambulance) in ETCs.

METHODS: We used ETCs with simulated patients (SPs), with each student randomly allocated two of four possible cases. After the training, 137 students reported on any insecurity that they had in the various ETC phases. We analysed the reasons for insecurity using descriptive statistics. The association between the students’ advice that urgent action was needed and their insecurity was analysed with Spearman rank correlation.

RESULTS: Overall, 95% of the students felt insecure in at least one phase of their ETC. History taking was the phase in which students felt most insecure (63.1%), followed by the phase of analysing the information given by the patient (44.9%). Perceived insecurity was associated with more urgent advice in one case scenario (abdominal pain; correlation r = 0.46; p <0.01). The other two cases (child with fever; chest pain) also had a positive, but not statistically significant, correlation trend (p <0.12; p <0.08).

CONCLUSIONS: Insecurity is highly prevalent among medical students in their ETC decision-making. ETC training in medical schools, with a focus on structured history taking and formulating discriminating questions, might help decrease insecurity in ETCs. Medical education should also teach management of insecurity.


  1. Car J, Freeman GK, Partridge MR, Sheikh A. Improving quality and safety of telephone based delivery of care: teaching telephone consultation skills. Qual Saf Health Care. 2004;13:2–3.
  2. Marty F, Meyer R, Lüscher S, Gnädinger M, Kissling B. Urgent consultations/emergencies to a general practitioner – a pilot study. Prim Care. 2006;6:345–7.
  3. Christensen MB, Olesen F. Out of hours service in Denmark: evaluation five years after reform. BMJ. 1998;316:1502–6.
  4. Leibowitz R, Day S, Dunt D. A systematic review of the effect of different models of after-hours primary medical care services on clinical outcome, medical workload, and patient and GP satisfaction. Fam Pract. 2003;20:311–7.
  5. Larsen J-H, Risor O. Telephone consultations at the emergency service, Copenhagen County: analysis of doctor-patient communication patterns. Fam Pract. 1997;14:387–97.
  6. Foster J, Jessopp L, Dale J. Concerns and confidence of general practitioners in providing telephone consultations. Br J Gen Pract. 1999;49:111–3.
  7. O’Donnell CA. Variation in GP referral rates: what can we learn from the literature? Fam Pract. 2000;17:462–71.
  8. Innes M, Skelton J, Greenfield S. A profile of communication in primary care physician telephone consultations: application of the Roter Interaction Analysis System. Br J Gen Pract. 2006;56:363–8.
  9. Huibers L, Keizer E, Giesen P, Grol R, Wensing M. Nurse telephone triage: good quality associated with appropriate decisions. Fam Pract. 2012;29:547–52.
  10. Derkx HP, Rethans J-JE, Maiburg BH, Winkens RA, Muijtjens AM, van Rooij HG, et al. Quality of communication during telephone triage at Dutch out-of-hours centres. Patient Educ Couns. 2008;74:174–8.
  11. Huibers L, Giesena P, Smitsa M, Mokkinkb H, Grola R, Wensinga M. Nurse telephone triage in Dutch out-of-hours primary care: the relation between history taking and urgency estimation. Eur J Emerg Med. 2011;19:309–15.
  12. Rutenberg CD. Telephone Triage. Am J Nurs. 2000;100:77–81.
  13. Patel A, Dale J, Crouch R. Satisfaction with telephone advice from an accident and emergency department: identifying areas for service improvement. Qual Health Care. 1997;6:140–5.
  14. Derkx HP, Rethans J-JE, Knottnerus JA, Ram PM. Assessing communication skills of clinical call handlers working at an out-of-hours centre: development of the RICE rating scale. Br J Gen Pract. 2007;57:383–7.
  15. McKinstry B, Watson P, Pinnock H, Heaney D, Sheikh A. Confidentiality and the telephone in family practice: a qualitative study of the views of patients, clinicians and administrative staff. Fam Pract. 2009;26:344–50.
  16. Donner-Banzhoff N. Umgang mit Unsicherheit in der Allgemeinmedizin. Z Evid Fortbild Qual Gesundhwes (ZEFQ). 2008;102:13–8.
  17. Morgan M, Jenkis L, Ridsdale L. Patient pressure for referral for headache: a qualitive study of GP’s referral behaviour. Br J Gen Pract. 2007;57:29–35.
  18. Wayne S, Dellmore D, Serna L, Jerabek R, Timm C, Kalishman S. The association between intolerance of ambiguity and decline in medical students’ attitudes toward the underserved. Acad Med. 2011;86:877–82.
  19. Car J, Sheikh A. Telephone consultations. BMJ. 2003;326:966–9.
  20. Giesen P, Ferwerda R, Tijssen R, Mokkink H, Drijver R, van den Bosch W, et al. Safety of telephone triage in general practitioner cooperatives: do triage nurses correctly estimate urgency? Qual Saf Health Care. 2007;16:181–4.
  21. Cykert S, Flannery MT, Huber EC, Keyserling T, Moses GA, Elnicki MD, et al. Telephone medical care administered by internal medicine residents: concerns of program directors and implications for residency training. Am J Med Sci. 1997;314:198–202.
  22. Schaufelberger M, Harris M, Frey P. Emergency telephone consultations: a new course for medical students. Clin Teach. 2012;9:373–5.
  23. Crouch R, Patel A, Williams S, Dale J. An analysis of telephone calls to an inner-city accident an emergency departement. J R Soc Med. 1996;89:324–8.
  24. Marklund B, Bengtsson C. Medical advice by telephone at Swedish Health Centres: who calls and what are the problems? Fam Pract. 1989;6:42–6.
  25. Wahlberg AC, Cedersund E, Wredling R. Telephone nurses’ experience of problems with telephone advice in Sweden. J Clin Nurs. 2003;12:37–45.
  26. Young MJ, Poses RM. Medical student perceptions of the value of the history and physical examination. J Med Educ. 1983;58:738–9.
  27. Holmboe ES. Faculty and the observation of trainees’ clinical skills: problems and opportunities. Acad Med. 2004;79:16–22.
  28. Goodwin J. The importance of clinical skills. BMJ. 1995;310:1281–2.
  29. Adler RH, Minder CE. Clinical competence of biopsychosocially trained physicians and controls. SMW. 2012;142:w13649.

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