Communication between consultants providing advice and referring physicians: a scoping review

Abstract

Objective

Communication during consultations between referring and consultant physicians is often cited as a source of adverse events, medical error and professional incivility. While existing literature focuses on the role of referring physicians, few studies acknowledge the role of consultant physicians in enhancing communication during consultations. This scoping review aims to identify and synthesise available recommendations to enhance the communication practices of consultants during real-time consultations.

Design

A scoping review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.

Data sources

Medline, EMBASE and PsycINFO databases were searched from inception to August 2022.

Eligibility criteria for selecting studies

English-language publications which describe recommendations, strategies or frameworks to improve the communication practices of consultant physicians during real-time consultations with referring physicians.

Data extraction and synthesis

The search strategy included the following concepts: consultation, physician, communication, interprofessional relations and best practice. Two authors independently performed each phase of title and abstract screening, full-text review and data extraction. Discrepancies were resolved by a third author. Extracted data were iteratively analysed and summarised thematically.

Results

Sixteen publications met the inclusion criteria. Synthesis of available recommendations identified organisation, expertise and interpersonal skills as three overarching and interconnected dimensions of communication demonstrated by consultants during effective consultations. Twelve studies identified interpersonal skills as being critical in alleviating the widespread professional incivility that is reported during consultations. Existing recommendations to improve the communication practices of consultants are limited as they lack standardised interventions and fail to comprehensively address all three elements identified in this review.

Conclusion

This scoping review synthesises available recommendations to improve the communication practices of consultant physicians during real-time consultations. An opportunity exists to develop communication tools or educational interventions based on the findings of this review to enhance interphysician consultation encounters.

STRENGTHS AND LIMITATIONS OF THIS STUDY.

• Our search was comprehensive, and we included an extensive body of literature, across healthcare settings, populations and study designs to establish recommendations to improve the communication of consultant physicians during consultations.

• We report our rigorous methodology in the format of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews to improve our review’s transparency and completeness.

• Stakeholder consultation involving two clinician researchers with relevant expertise was undertaken to ensure the rigour of methods and findings.

• It is possible that relevant citations, including non-English publications and grey literature beyond those included as conference abstracts, were inadvertently missed.

• This study did not critically appraise the quality or impact of included publications.

Introduction

Interprofessional consultations are an integral part of medical practice. However, communication breakdowns between referring and consultant physicians during consultations have been consistently implicated as causes of medical error and adverse patient outcomes. In 2004, the Canadian Adverse Events Study reviewed a random sample of 3745 adult medical records from 20 Canadian hospitals. Breakdowns in communication between healthcare providers were identified as a root cause of adverse events—preventable patient incidents that result in serious harm, death, disability or a prolonged hospital stay.¹ Similarly, the Joint Commission on the Accreditation of Healthcare Organisations identified communication failures between healthcare providers as a leading cause of the adverse events reported by over 22 000 healthcare organisations in the USA between 2010 and 2022.² Furthermore, a rise in professional incivility in healthcare settings has further implications for patient care, interpersonal relationships and productivity.^{3 4} One retrospective study found that over 30% of physician respondents from the National Health Service in England reported experiencing rude, dismissive or aggressive communication that adversely affected their workday.⁴ A recent systematic review of bullying within academic medical settings identified consultants as the most common perpetrators, owing to the hierarchical nature of medical systems.⁵ The consultation encounter, marked by power imbalances between the referring physician seeking knowledge and the consultant physician holding expertise, creates an operational environment where professional incivility is more likely to flourish.

To mitigate communication failures, several evidence-based frameworks (ie, The 5Cs of Consultation, PIQUED and SBAR) have been developed to enhance communication between physicians during consultations.^6–8 However, these standardised models largely neglect the behaviours of consultant physicians during consultations. Instead, they emphasise the importance of the structure and content of the consultation request and the behaviours of the referring physician. When exploring the role of consultants in improving the consultation process, several studies reference recommendations outlined by Goldman et al in their 1983 essay titled ‘Ten Commandments for Effective Consultations’.⁹ These commandments urge consultants to determine the consultation question, establish urgency, gather primary data, be concise in communication, provide specific recommendations, clarify their responsibilities, educate referring physicians, communicate directly with the referring physician and provide follow-up as appropriate.⁹ Although these recommendations were highly influential in establishing the role of consultants during consultations, they are opinion-based rather than evidence-based and directed towards asynchronous consults. Asynchronous consults refer to consultation processes where interactions between healthcare providers occur at different times, often involving written exchanges of information. A study by Salerno et al suggests that consultation practices have evolved since Goldman et al’s essay due to increasing advancements in technology.¹⁰ Increasing use of technology lends to more real time, synchronous communication (eg, in-person or telephone) between physicians during consultations. Furthermore, these advancements have increased access to consultant expertise, thereby increasing consult volumes and demands on consultant physicians.

There is a lack of literature that addresses the behaviours of consultant physicians in enhancing communication during consultations and which also considers modern consultation trends and practices. Given that real-time consultations are increasingly popular in patient care provision and that communication during consultations is bidirectional, the role of the consultant physician must be clarified. Therefore, a scoping review was conducted to identify and synthesise available recommendations to improve the communication practices of consultants during real-time consultations. A scoping review was particularly well suited to our research objective in mapping the breadth existing literature, including both qualitative and quantitative studies, to identify key themes, gaps and emerging trends in the evolving landscape of interphysician communication. By offering a comprehensive overview of available evidence, we aim to offer insights that can inform the development of evidence-based guidelines to enhance the communication practices of consultants during real-time consultations.

Methods

Study design

This scoping review was conducted following the methodological framework suggested by Arksey and O’Malley and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.^{11 12} The protocol was registered on the Open Science Framework (online supplemental appendix 1). The search strategy (online supplemental appendix 2) was developed by a medical librarian (EW) in collaboration with the research team and included the following concepts: consultation, physician, communication, interprofessional relations and best practice. The MEDLINE search strategy was posted on the PRESSforum website and peer reviewed by two librarians. Medline, EMBASE and PsycINFO databases were simultaneously searched on the Ovid platform. The search was last run on 30 August 2022, to identify English-language publications with an available abstract. Deduplication was performed on the Ovid platform and then automatically by the Covidence software on upload.

Study selection

Journal articles and conference abstracts were eligible for inclusion if they were written in English and described recommendations, strategies or frameworks to improve the communication practices of consultant physicians during real-time (eg, in person or telephone) consultations. Articles were excluded if they did not provide explicit recommendations, strategies or frameworks to improve the communication practices of consultant physicians or did not pertain to real-time consultations (eg, asynchronous or written consultations) (table 1). Titles and abstracts of articles were screened by three authors (AM, TO and DG) such that each article was screened by two independent authors. Articles which met inclusion criteria were subjected to full-text review by two independent authors (AM and TO). Discrepancies were resolved by an independent third author (JS).

Table 1.

Inclusion and exclusion criteria for the scoping review

	Inclusion criteria	Exclusion criteria
Publication type	Articles and abstracts published in peer-reviewed journals English From inception to August 2022	Non-English
Population	Physicians and medical trainees including fellows, residents and medical students	Any articles which did not include physicians and medical trainees including fellows, residents and medical students
Setting	Real-time consults Primary, secondary or tertiary care	Asynchronous or written consults
Outcome	Recommendations, strategies or frameworks to improve communication practices of consultant physicians during consultations	Any articles which do not provide recommendations, strategies or frameworks to improve communication practices of consultant physicians during consultations

Data extraction and analysis

The research team collaboratively designed a data-charting form using Microsoft Excel based on our research aims (online supplemental appendix 3). The initial data-charting form was piloted using a random sample of five articles and iteratively revised. On finalising the data-charting form, articles eligible for inclusion were extracted and charted by two independent authors (AM and TO). Extracted recommendations were coded into phrases and organised into a working list of key themes by two authors (AM and TO) guided by sensitising concepts based on our initial familiarity with the literature: structure of advice, content of advice and behaviours of consultant physicians. However, key themes and subthemes were iteratively added to this list throughout data extraction and analysis.

Consultation

To ensure the rigour of our methods and findings, stakeholder consultations involving two clinician researchers with scholarly expertise in interphysician communication were undertaken. The consultation consisted of a one-on-one interview with the consulting members, during which the lead investigators (AM and TO) presented and discussed the study design, search strategy, extracted data and identified themes. Feedback was elicited to identify any gaps in the search, scope, or analysis of the literature. Suggestions from the consulting team were incorporated into our analyses, which are reflected in the results section.

Patient and public involvement

Patients and the public were not involved in the design, reporting or dissemination of this scoping review.

Results

Study selection

The search strategy generated a total of 11 521 publications, 11 445 of which were excluded after title and abstract screening, from which another 60 were excluded during full-text review. A total of 16 studies were included in this scoping review (figure 1).

Figure 1.

Flow chart.

Study characteristics

Of the 16 included publications, 13 were journal articles and 3 were available only as conference abstracts. Ten studies were conducted in the USA, four in Canada, one in France and one in Japan. Studies that met inclusion criteria were published between 1983 and 2021. Eleven studies were published from 2011 to 2022. Four studies were published from 2010 to 2000. One study was published prior to 2000.

Research methodologies

Most studies employed qualitative designs using grounded theory or basic interpretive methods (n=12). Three studies utilised mixed-method designs, of which one was a quality improvement study. One study employed quantitative designs using survey data.

Setting

Most studies were conducted in tertiary urban care centres (n=13). Two studies involved physicians from primary, secondary and tertiary urban care centres. One study was conducted at both secondary and tertiary urban care centres.

Characteristics of study subjects

Four studies included only attending physicians, while four studies included only resident and/or fellow physicians, seven studies included physicians at all levels of training, and one study included attending physicians and two nurse practitioners. Age and years of practice for subjects were not available in the majority of studies. Additionally, only seven studies specified the sex of the subjects. Study subjects represented a variety of generalist and specialist services, as demonstrated in table 2.

Table 2.

Descriptive data of articles included in scoping review

First author	Location	Design	Setting	Subjects	Field	Focus	Themes identified
Kessler7	USA	Qualitative	Tertiary care	Attending physicians	Emergency medicine, anaesthesiology, general and subspecialty internal medicine, general and subspecialty surgery	Consultant and referring physicians	Organisation, expertise, interpersonal skills
Chan8	Canada	Qualitative	Tertiary care	Attending and resident physicians	Emergency medicine, internal medicine, general surgery	Consultant and referring physicians	Organisation, expertise
Salerno10	USA	Quantitative	Tertiary care	Attending and resident physicians	Family medicine, general internal medicine, general surgery, orthopaedic surgery, obstetrics and gynaecology	Consultant and referring physicians	Organisation, expertise
Stevens13	USA	Qualitative	Tertiary care	Attending physicians	Pulmonary and critical care	Consultant and referring physicians	Organisation, expertise, interpersonal skills
Heiselman14	USA	Mixed methods	Tertiary care	Physicians, unspecified	Various specialties, unspecified	Consultant and referring physicians	Organisation, expertise
Peccoralo15	USA	Qualitative	Tertiary care	Resident physicians	Internal medicine	Consultant and referring physicians	Organisation, expertise, interpersonal skills
Cook16	USA	Qualitative	Primary, secondary and tertiary care	Physicians, unspecified	Family medicine, general and subspecialty internal medicine	Consultant and referring physicians	Organisation, expertise, interpersonal skills
Matsuo17	Japan	Mixed methods	Tertiary care	Fellow and resident physicians	Emergency medicine, internal medicine, paediatrics, surgery, obstetrics and gynaecology	Consultant physicians	Organisation, expertise, interpersonal skills
Couperus18	USA	Qualitative	Tertiary care	Physicians, unspecified	Emergency medicine	Consultant and referring physicians	Organisation, expertise, interpersonal skills
Lee19	USA	Qualitative	Tertiary care	Physicians, unspecified	General and subspecialty medicine, general subspecialty surgery, obstetrics and gynaecology	Consultant and referring physicians	Organisation, expertise
Stille20	USA	Qualitative	Secondary and tertiary care	Attending physicians Nurse practitioners	General and subspecialty paediatrics	Consultant and referring physicians	Organisation, expertise, interpersonal skills
Sibert21	France, Canada	Qualitative	Primary, secondary and tertiary care	Attending and resident physicians	Urology, internal medicine subspecialists, primary care	Consultant and referring physicians	Organisation, expertise, interpersonal skills
Wadhwa22	Canada	Qualitative	Primary, secondary and tertiary care	Attending physicians	Paediatrics, family medicine	Consultant and referring physicians	Organisation, expertise, interpersonal skills
Chan23	Canada	Qualitative	Tertiary care	Attending and resident physicians	Emergency medicine, internal medicine and general surgery	Consultant and referring physicians	Organisation, expertise, interpersonal skills
Pavitt24	USA	Mixed methods (quality improvement)	Tertiary care	Fellow and resident physicians	Paediatrics	Consultant and referring physicians	Organisation, expertise, interpersonal skills
Chan25	Canada	Qualitative	Tertiary care	Attending and resident physicians	Emergency medicine, internal medicine, general surgery	Consultant and referring physicians	Organisation, expertise, interpersonal skills

Key communication practices of consultants during consultations

As summarised in table 3, review of included studies revealed organisation, expertise and interpersonal skills as essential components of consultant communication during consultations.

Table 3.

Key components of consultant communication

Organisation	Respond to the consultation request in a timely fashion Identify oneself and allow others to identify themselves Communicate with the referring physician directly Clarify the reason for the consultation Establish the urgency of the request Listen first and then ask questions Provide a limited number of specific recommendations with rationale and contingency plans Provide a limited number of specific recommendations with rationale and contingency plans Close the loop
Expertise	Leverage available patient data Approach the consultation as an educational tool
Interpersonal Skills	Establish trust Foster familiarity Demonstrate collegiality

Organisation

Organisation highlights chronological and structural aspects of consultant communication during consultations. Eight components of organisation were commonly discussed: (1) respond to the consultation request in a timely fashion; (2) identify oneself (name, rank, year and service) and allow others to identify themselves; (3) communicate with the referring physician directly; (4) clarify the reason for the consultation; (5) establish the urgency of the request; (6) listen first and then ask questions; (7) provide a limited number of specific recommendations with rationale and contingency plans and (8) close the loop.

Respond to the consultation request in a timely fashion

Several articles emphasise the importance of a consultant’s promptness in responding to the initial consultation request.^{7 13–17} However, personal and professional obligations may hinder timely responses.^{16 17} Therefore, prior to responding to a request, consultants should consider the appropriateness of their location and availability to ensure they can conduct the consultation without interruptions.^{16 17}

Identify oneself and allow others to identify themselves

At the start of a consultation, it is recommended to introduce the referring and consultant parties by name, rank, year and service, along with patient identification.^{7 8 18} Identification is crucial as medical trainees and other interprofessional providers may be involved in the consultation process.7 8 19 20 Proper identification of the referring physician also allows the consultant to take into account the referring physician’s needs^{17 21} and promotes relationship building.⁷

Communicate with the referring physician directly

Most of the studies reviewed emphasised direct, verbal communication between the consultant and referring physicians during consultations.^{10 14–21} The many layers of providers involved in patient care can create breakdowns in communication due to incomplete, fragmented or delayed transfers of information.^{19 20} Direct, verbal communication with the referring physician promotes bidirectional information exchange and enables prompt answers to clinical questions, especially in urgent or emergent situations.^{16 21}

Clarify the reason for the consultation

Early in the consultation, the consultant physician should identify the reason for the consultation request to determine whether they are the appropriate consultant and to promote agreement with the referring physician.7 8 10 15 16 19–21 A retrospective study evaluating the effectiveness of consultations found that referring physicians were more likely to incorporate consultants’ advice on diagnosis and management when there was agreement as compared with discrepancy in the reason for the consultation request.¹⁹

Establish the urgency of the request

Along with clarifying the reason for consultation, it is crucial for the consultant physician to establish the urgency of the request.8 10 13 17 21 The consultant must consider the referring physician’s clinical context and expertise in ascertaining whether the consultation is emergent, urgent or elective and respond accordingly.8 10 13 17 21

Listen first and then ask questions

During the consultation process, it is anticipated that the consultant physician will ask questions to gather further information from the referring physician to inform their advice.8 16 19 22 It is important that the consultant poses these questions after the referring physician completes their initial presentation to minimise interruption and subsequent fragmentation in information transfer.^{8 22}

Provide a limited number of specific recommendations with rationale and contingency plans

Reviewed studies suggest that consultant recommendations are more likely to be followed if they are concise, specific and lead to actionable outcomes.7 10 13 17 19 21 22 For example, consultants should be explicit in specifying additional investigations or interventions such as drug dosage, frequency and route.^{19 21} In contrast, overly exhaustive consultant recommendations are less likely to be implemented by the referring physician.^{19 21} Given that the advice provided by consultants varies depending on the clinical context and needs of the referring physician, consultants may consider including explanations and contingency plans when providing expert advice to referring physicians.10 13 17 20–22

Close the loop

Closed-loop communication is a critical aspect of organisation and includes clarifying roles and responsibilities for the referring and consultant physicians, planning follow-up if appropriate and confirming agreement with the plan.7 8 10 16–21 23 24 Closed-loop communication also enables both the consultant and referring physicians to provide and elicit feedback.^{8 17 24}

Expertise

Expertise acknowledges the consultant physician’s role in facilitating the exchange of knowledge and information. This is accomplished by leveraging available patient data and approaching the consultation as an educational tool.

Leverage available patient data

Adoption of telemedicine and electronic health records enhances accessibility to consultant expertise and provides consultants with additional means to gather patient information.^{10 20} Reviewed studies suggest that electronic access to patient information and investigations is not only desired by consultants, but also enhances the perceived efficacy of consultations when combined with the information gathered from the referring physician.^{10 20} By reviewing available health records, consultant physicians may uncover overlooked information or otherwise enhance their diagnostic evaluation to provide accurate patient care recommendations.^{10 20}

Approach the consultation as an educational tool

Consultations serve as an opportunity for continuing medical education and interprofessional development. To maximise these opportunities, consultants should consider the referring physician’s characteristics and learning needs.8 10 13 15 17 19–24 For instance, consultants can tailor their communication based on the level of training (eg, medical student, resident, fellow or attending) or focus (eg, generalist or subspecialist) of the referring team member or the urgency of the consult.^{10 13 19} Consultants can further enhance the educational potential of a consult by eliciting and answering questions from the referring team, providing a rationale for recommendations, suggesting relevant resources, summarising key learning points for the clinical case or offering feedback on communication skills.8 10 17 19 20 22 24

Interpersonal skills

Interpersonal factors including trust, familiarity and collegiality play a critical role in shaping the interactions between referring and consultant physicians during consultations. While 12 studies acknowledge the role of social dynamics during consultations, they vary in the extent to which they emphasise the importance of these interpersonal factors in their recommendations.7 13 15–18 20–25

Establish trust

Trust is a key interpersonal factor that influences communication during the consultation process. A study by Chan et al found that conflicts during consultations are attributed to an absence or breach of trust, while trust-building activities may prevent or mitigate conflicts.²³ Consultants can build trust by demonstrating consistency and reliability in their willingness to provide expertise and support.^{18 23 25} When the consultant and referring physicians are unfamiliar with one another, trust may be established by identifying personal connections or emphasising the shared goal of patient-centred care.13 18 23 25 Building trust is a reciprocal process, whereby the consultant must also demonstrate their willingness to trust the referring physician’s assessment of the patient and collaborate on a plan of care.^23–25 Breaches of trust, including lapses in professionalism, may be addressed by a direct apology.¹⁸

Foster familiarity

Familiarity between referring and consultant physicians was found to enhance communication during consultations.17 18 23 25 This familiarity is often established through repeated exposure, personal experience and reputation.^{18 23 25} Opportunities exist to enhance familiarity beyond the consultation encounter through combined conferences, joint postgraduate pathways, off-service rotations and sharing educational or occupational experiences.^{17 18 25} Chan et al suggest that familiarity improves communication during consultations through a reciprocal process whereby familiarity facilitates trust and vice versa.^{23 25} Their study also found that consultant physicians were more likely to allow familiar referring physicians to use representative language as opposed to explicit details to convey information (ie, describing a patient as ‘stable’ vs providing a patient’s vital signs).²⁵ Familiarity was also found to facilitate consultations through awareness of physician-specific or service-specific practice patterns.¹⁸

Demonstrate collegiality

Collegiality encompasses the relational atmosphere established between referring and consultant physicians during consultations. Collegiality is facilitated by attitudes and behaviours which demonstrate a disposition towards respect and engagement.7 13 15–18 20–22 24 Although highly subjective, several studies illustrate common strategies through which consultants can promote collegiality during consultations. To demonstrate respect, consultants should listen without interruption, communicate without condescension or emotional fluctuations, compliment other services and apologise for any lapses in professionalism.^{7 17 22} To demonstrate engagement, consultants should be willing to support others, promote education and provide feedback.13 17 18 20 21

Discussion

This scoping review aimed to synthesise the best available evidence to enhance consultant communication practices during real-time consultations. Review of the current literature suggests that organisation, expertise and interpersonal skills are overarching and interconnected elements of communication demonstrated by consultants during effective consultations. Despite the heterogeneity in clinical settings and populations of the studies included, consistent themes emerged that defined key recommendations to improve consultant communication. This suggests that the derived recommendations can be broadly applied and that an opportunity exists to standardise consultant communication during real-time consultations.

Approaches for consultant physicians to demonstrate organisation, expertise and interpersonal skills were easily identifiable during the progression of this scoping review’s analysis. However, no unifying framework or model was found which adequately defined all three elements. Goldman et al ‘Ten Commandments for Effective Consultation’ (determine the consultation question, establish urgency, gather primary data, be concise in communication, provide specific recommendations, clarify their responsibilities, educate referring physicians, communicate directly with the referring physician and provide follow-up as appropriate) highlight key elements pertaining to the organisational skills and expertise demonstrated by consultants during consultations.⁹ However, the Ten Commandments focus on asynchronous consults conducted by internal medicine physicians, thereby limiting their generalisability to contemporary consultation practices which include real-time consultations across diversified medical and surgical services. Additionally, the Ten Commandments do not address the relational dynamics of the consultation process as highlighted by our synthesis of available frameworks.

In their PIQUED (preparation, identification, urgency, educational modifications and debrief) framework, Chan et al emphasise organisation in addition to expertise by highlighting approaches for consultants to educate the referring physician.⁸ This is particularly important given the involvement of medical trainees in the consultation process and the broader role of consultations in continuing medical education. Kessler et al similarly identified organisation, medical knowledge and interpersonal skills as essential components of effective consultations.⁷ Using these themes, Kessler et al established the 5Cs of Consultation (contact, communicate, core question, collaboration and close the loop).⁷ The 5Cs of consultation, unlike previous frameworks, recognises the role of consultant physicians and relational dynamics during consultations through the themes of contact, collaboration and closing the loop. Yet, the focus of the framework remains on the referring physician.

Chan et al further inform the relational dynamics of the consultation by exploring the impact of perceived trust and familiarity on the consultation process, however, are limited in their contribution to the identified themes of organisation and expertise.^{23 25} Ultimately, the utility and generalisability of existing recommendations to improve the communication practices of consultants are limited as they lack operational definitions and standardised interventions that adequately describe all three elements identified in this review.

This scoping review employed a comprehensive search strategy to map the existing literature and clarify the role of consultant physicians in enhancing communication during consultations. An opportunity exists to develop communication tools or educational interventions based on the findings of this review to improve the communication practices of consultant physicians. The need for theoretical foundations in developing effective educational interventions and process improvement efforts is asserted by numerous knowledge translation models. The knowledge to action framework is a frequently cited model of knowledge translation that was first described by Graham et al.²⁶ The framework divides knowledge translation into two components: knowledge creation and action cycle. Knowledge creation entails inquiry and evaluation of primary literature, grouping and synthesis of available data, and development of knowledge tools such as explicit recommendations, guidelines and protocols.²⁶ The action cycle involves applying the knowledge created to develop, implement and evaluate interventions.²⁶ Our study fulfils the knowledge creation component of this model in developing a rich description of the available recommendations to improve consultant physician communication during consultations. Explicit use of theoretical foundations established in this review may be implemented by future studies through interventions to enhance consultant physician communication, evaluative processes that assess the implementation of interventions, and all research which seeks to evaluate the impact of improved consultant communication on clinical process, physician and patient outcomes.

Our scoping review has several limitations. First, although we aimed to construct a comprehensive search strategy and search several databases, it is possible that relevant citations were inadvertently missed. Second, several potentially relevant studies were excluded from the review as they were opinion-based rather than evidence-based research studies. Third, this review only includes studies written in English. Fourth, we did not assess the quality or impact of included publications as our goal was to provide a comprehensive overview of available literature to map key concepts and identify gaps for future research. Finally, the heterogeneity in research settings, subjects and reported outcomes across studies included in this review precludes comparative analysis of available recommendations with respect to potentially confounding factors including age, sex, level of training or years of practice.

Conclusion

This scoping review maps available recommendations to improve consultant communication during real-time consultations. Synthesis of available recommendations highlights the importance of organisation, expertise and interpersonal skills in consultant communication. An opportunity exists to develop communication tools or educational interventions based on the findings of this review to enhance the communication practices of consultant physicians during consultations.

Data availability statement

No data are available.

Ethics statements

Patient consent for publication

Not applicable.