Best Practices for Teaching Verbal De-Escalation in Health Professions Education: A Systematic Review

INTRODUCTION Workplace violence is very prevalent in acute healthcare settings, where healthcare providers are responsible for managing agitated patients and visitors. The widely accepted preferred first line management of agitation within healthcare is verbal de-escalation. Despite widespread acknowledgement of its importance, formalized training in the skill of verbal de-escalation is grossly lacking across health professions education (HPE). Even more foundationally, consensus on how best to teach the skill of de-escalation is absent in the HPE landscape. This systematic review endeavors to outline the characteristics of existing curricula within HPE that aim to teach de-escalation skills, to determine how strong the outcomes of these curricula are in accordance with Best Evidence Medical Education guidelines and Kirkpatrick’s model of educational outcomes, and to outline the consequent best practices for how to teach the de-escalation of agitated patients or visitors to health professionals. METHODS A literature review was performed by searching PubMed, EMBASE, ERIC (EBSCOhost), and Google Scholar to identify studies that looked at any empirical outcomes from educational interventions designed to teach de-escalation to health professionals. Two authors independently screened for relevant articles and performed the data extraction. Each study was assigned a BEME Strength of Evidence score as well as assessed via the Medical Education Research Study Quality Instrument (MERSQI). RESULTS The literature search returned 3788 unique manuscripts, 46 of which met the inclusion criteria. Nine studies had BEME scores of 4 or 5, indicating strong evidence. MERSQI scores ranged from 5.5 – 16, with a mean (SD) of 10.36 (2.56). More than half of the learning interventions were targeted to nurses, but studies also included physicians, nursing students, medical students, patient care associates, and other hospital staff. The interventions with strong evidence all used either role-play and/or simulation as part of their teaching methodology. Two of the most evidence-supported frameworks for verbal de-escalation are the Ten Domains of De-escalation by the American Association for Emergency Psychiatry, and the De-escalating Violence in Health-care Settings Trainer Manual by the International Committee of the Red Cross. CONCLUSIONS The available evidence suggests that the most effective way to teach de-escalation within health professions education is through a combination of lecture, discussion, and active skills practice through role-play or simulation.