Interprofessional and Team Communication
Domain 5: Interprofessional and Team Communication
The exam tests structured handover, closed-loop communication, escalation, and speaking up across hierarchy.
Core rules
- SBAR: Situation, Background, Assessment, Recommendation. Say what you need: "I need you to review him within 10 minutes."
- Close the loop: the receiver repeats back the instruction and the sender confirms. Read-back is mandatory for high-alert drugs, critical results, and verbal orders.
- Handover: use I-PASS (Illness severity, Patient summary, Action list, Situation awareness and contingency planning, Synthesis by receiver) or the local standard. Include what has changed and what to watch for.
- Briefings and huddles set shared plans; debriefs after events should be blame-free and systems-focused.
- Psychological safety predicts speaking up. Flatten hierarchy explicitly: "Anyone can stop the line if something feels wrong."
- Graded assertiveness: a clear statement first, then escalate using CUS (Concerned, Uncomfortable, Safety issue), the two-challenge rule, or PACE (Probe, Alert, Challenge, Emergency).
- Document handovers and escalation conversations with time and content.
Worked example
A ward nurse calls about a 72-year-old with new confusion: "This is Aisha on Ward 4. Mr Khan, 72, has become confused; BP is 85/50, HR 120, urine output low. I think he is septic. He needs review now and I have started fluids per protocol." The doctor repeats back the plan, attends, and documents. SBAR plus a clear recommendation gets the patient seen.
Traps
- Hinting ("I'm a bit worried about bed 6") instead of stating the problem and the request.
- "No news is good news" - silence is not confirmation of a plan.
- Handovers that omit pending results, contingency plans, and illness severity.
- Using a debrief to name and shame, which suppresses future reporting.