Best practices for teaching verbal de-escalation in health professions education: a systematic review

Workplace violence is prevalent in settings where health care practitioners are responsible for managing agitated patients and visitors. First-line management of agitation within health care is verbal de-escalation. However, formal training in verbal de-escalation is not standardized across health professions education (HPE), and consensus about best practices is lacking. This systematic review examines the characteristics of existing curricula within HPE that teach de-escalation skills, assesses the research quality and strength of evidence of these studies, and outlines consequent best practices for teaching the skill of de-escalation to health professionals.

PubMed, EMBASE, ERIC (EBSCOhost), and Google Scholar were searched using terms related to HPE, aggression, and de-escalation for work published from database inception to July 22, 2025. Studies on empirical outcomes from curricula designed to teach de-escalation to health professionals were included. Included studies were assigned scores on the Medical Education Research Study Quality Instrument (MERSQI) and an adapted version of the Best Evidence Medical Education (BEME) strength of evidence scale. A narrative synthesis approach was adopted.

Of 4,312 unique records identified, 56 studies met the inclusion criteria. Twelve had BEME scores of 4 or 5, indicating strong evidence. MERSQI scores ranged from 5.5 to 16.0, with a mean (SD) of 10.4 (2.5). Learning interventions were targeted to nurses, physicians, students, and hospital staff. The interventions with strong evidence all incorporated both didactic education as well as role-play and/or simulation for active practice. The Ten Domains of De-escalation by the American Association for Emergency Psychiatry and the De-escalating Violence in Healthcare Settings curriculum by the International Committee of the Red Cross were referenced by multiple studies.

Available literature suggests that the most evidence-supported way to teach de-escalation within HPE is through a combination of didactic lessons and active skills practice.