Effectiveness of a course designed to teach handoffs to medical students

COVID-19 related disruptions to medical education and perceived clinical capability of new resident physicians: a nationwide study of over 1200 first-year residents

The COVID-19 pandemic transformed the final year of undergraduate medical education for thousands of medical students across the globe. Out of concern for spreading SARS-CoV-2 and conserving personal protective equipment, many students experienced declines in bedside clinical exposures. The perceived competency of this class within the context of the pandemic is unclear. We designed and distributed a survey to measure the degree to which recent medical school graduates from the USA felt clinically prepared on 13 core clinical skills. Of the 1283 graduates who matched at HCA Healthcare facilities, 90% (1156) completed the survey. In this national survey, most participants felt they were competent in their clinical skills. However, approximately one out of four soon-to-be residents felt they were clinically below where they should be with regard to calling consultations, performing procedures, and performing pelvic and rectal exams. One in five felt they were below where they should be with regard to safely transitioning care. These perceived deficits in important skill sets suggest the need for evaluation and revised educational approaches in these areas, especially when traditional in-person practical skills teaching and practice are disrupted.

Evaluating the Association of a Core EPA-Oriented Patient Handover Curriculum on Medical Students' Self-reported Frequency of Observation and Skill Acquisition

INTRODUCTION

"Giving or receiving a patient handover to transition patient care responsibility" is one of the thirteen Core Entrustable Professional Activities (Core EPAs) for Entering Residency. However, implementing a patient handover curriculum in undergraduate medical education (UME) remains challenging. Educational leaders in the multi-institutional Core EPA8 pilot workgroup developed a longitudinal patient handover UME curriculum that was implemented at two pilot institutions.

MATERIALS AND METHODS

We utilized multi-school graduation questionnaire data to assess the association of our patient handover curriculum on self-reported frequency of observation/feedback and skill acquisition by comparing data from the shared curriculum schools to data from other Core EPA pilot schools (three schools with school-specific curriculum; five without a dedicated handover curriculum). Questionnaire data from 1,278 graduating medical students of the class of 2020 from all ten Core EPA pilot schools were analyzed.

RESULTS

Graduates from the two medical schools that implemented the shared patient handover curriculum reported significantly greater frequency of handover observation/feedback compared to graduates at the other schools (school-specific curriculum (p < .05) and those without a handover curriculum (p < .05)). Graduates from the two shared approach schools also more strongly agreed that they possessed the skill to perform handovers compared to graduates from the other eight pilot schools that did not implement this curriculum.

CONCLUSION

The findings of this study suggest that the implementation of a multi-institutional Core EPA-based curricular model for teaching and assessing patient handovers was successful and could be implemented at other UME institutions.

Using a Direct Observation Tool (TOC-CEX) to Standardize Transitions of Care by Residents at a Community Hospital

Background: High-quality transitions of care are crucial for patient safety in hospitals, yet few undergraduate curricula include transition-of-care training. In 2012, the Wayne State University Office of Graduate Medical Education (WSUGME) required its residency programs to use the SAIF-IR mnemonic (summary, active issues, if-then contingency planning, follow-up activities, interactive questioning, readback) to ensure accurate and uniform handoffs. Subsequent program evaluations indicated that resident awareness and adoption of the mnemonic at our primary clinical site, Ascension Providence Rochester Hospital (APRH), could be improved. According to our institution's 2016 Clinical Learning Environment Review (CLER), 88% of residents reported following a standardized transition of care handoff, and 53% reported that faculty rarely supervised their handoffs. A 2016 WSUGME internal survey also revealed low rates of awareness (7% to 10%) of the mandated mnemonic. WSUGME then created a direct observation tool, the Transitions of Care-Clinical Evaluation Exercise (TOC-CEX), for faculty to monitor resident skill in using the mnemonic and thus standardize transitions of care as a practice habit at APRH. Methods: Since 2014, WSUGME had relied on 2 methods for training residents in the required handoff mnemonic: (1) introduction to the SAIF-IR mnemonic during the WSUGME orientation for all interns and (2) simulations during an objective simulated handoff evaluation activity for all postgraduate year (PGY) 1s and PGY 2s. In 2017, WSUGME innovated a direct observation tool, the TOC-CEX, for adoption by faculty at APRH to assess resident knowledge of and monitor their skill in using the SAIF-IR mnemonic in 3 primary care programs. The total number of possible participants was 138, and the actual number of individuals in the sample was 95. A majority (86%) of the observations during the study period were of PGY 1 residents, and thus the analysis reflects the ratings of 99% of all interns but only 69% of all possible residents. Results: WSUGME found that faculty use of a direct observation instrument in the clinical learning environment during 2017-2019 increased awareness and adoption of the SAIF-IR mnemonic among residents. Using a z-test of equal proportions on resident responses on an internal WSUGME survey, we found a significant rise in the percentage reporting yes to the question "Does your program have a mechanism for monitoring handoffs?" (χ2 [3]=23.6, P<0.0001) and in the percentage identifying SAIF-IR in response to the question "Does your program endorse a specific mnemonic for organizing the contents of a verbal handoff?" (χ2 [3]=45.0, P<0.0001). The increase from 2016 to 2017 is the result of the implementation of the TOC-CEX in the interim (question 1: χ2 [1]=12.4, P<0.0005; question 2: χ2 [1]=10.1, P<0.0025). Conclusion: Our research found that use of the TOC-CEX to monitor resident handoffs resulted in improved awareness and adoption of the SAIF-IR mnemonic in the clinical learning environment. Program leadership reported that the practice was both feasible and well accepted by residents, faculty, and the APRH chief medical officer as the TOC-CEX became a customary component of APRH organizational culture and was perceived as central to quality patient care.

Cross-Cover Curriculum for Senior Medical Students

INTRODUCTION

Cross-cover, the process by which a nonprimary team physician cares for patients, usually during afternoons, evenings, and weekends, is common in academic medical centers. With the advent of residency duty-hour restrictions, cross-cover care has increased, making education in effective cross-coverage an urgent need.

METHODS

We implemented a cross-cover didactic activity composed of 18 interactive cases with 29 senior medical students enrolled in an internal medicine residency preparation course. The curriculum was facilitated by one faculty member and one senior medical resident and utilized think-pair-share learning techniques to discuss an approach to a range of common (both urgent and routine) cross-cover scenarios. We analyzed confidence and feelings of preparedness pre- and postintervention. We also examined differences in medical knowledge based on two multiple-choice written cross-cover cases that addressed both medical management and triage.

RESULTS

This curriculum significantly improved feelings of confidence (from 1.8 to 3.2, p < .0001), reduced anxiety (from 4.5 to 4.1, p < .03), and improved performance in clinical case scenarios (from 82% to 89%, p < .02).

DISCUSSION

This curriculum covered not only the important medical aspects of cross-cover care (e.g., diagnostics and management) but also equally important roles of cross-cover, such as how to effectively triage cross-cover scenarios. The curriculum was well received by students.

Integrating handover curricula in medical school

BACKGROUND

Transitions of care are a patient-safety priority. Constructs such as SBAR (situation, background, assessment, recommendation) and I-PASS (illness severity, patient summary, action list, situation awareness, synthesis by receiver) have been used to teach the benefit of structured handovers and have demonstrated an impact in simulated and clinical environments. Despite this, there is still a lack of literature describing handover training for medical students that allows early and sustained knowledge and skill acquisition.

METHODS

We designed a curriculum to teach handovers to medical students that spanned 28 months of a 4-year medical education curriculum at a large medical school. The curriculum included two separate workshops that book-ended medical student core clerkships. The curriculum was evaluated via knowledge-based surveys and open-ended feedback from students.

RESULTS

Two-hundred and forty students participated in the first 'Transition to clerkship' (T2C) workshop. There was improvement in the mean scores on a knowledge-based survey after the workshop (p < 0.001). The overall improvement in performance remained significant 1 year later (p < 0.001). Following the second, 'Residency essentials' (RE) workshop, students demonstrated marginal improvement in knowledge when compared with scores immediately post-T2C and pre-RE. There was overall improvement from pre-T2C to post RE.

DISCUSSION

We outline the design and facilitation of two workshops for a large medical school class, as book-ended curricula before and after the clerkship phase of education. This project highlights the need for targeted learning and practice in handover delivery during clinical rotations to maintain and continually improve skills. We describe vertically integrated curricula that are logistically plausible, meaningful and beneficial.

Analysis of abbreviations used by residents in admission notes and discharge summaries

BACKGROUND

There are abbreviations that are used daily such as BP for blood pressure and ECG for electrocardiogram, but many of the abbreviations found in medical documents are unclear.

AIM

The purpose of this study was to assess the frequency, type and comprehension of abbreviations in admission notes and discharge letters composed by orthopedic surgery and medical residents.

METHODS

Abbreviations were extracted from discharge letters and admission notes composed by residents from orthopedic surgery and medical wards. The frequency of use of the abbreviations was determined. Additionally, the fifty commonest abbreviations from each specialty were graded by three medical and three orthopedic surgery senior physicians as 1. understandable or 2. Ambiguous or unknown.

RESULTS

The number of abbreviations found in the documents composed by medical and orthopedic surgery residents was 1525 with 80 different abbreviations and 493 with 51 different abbreviations respectively (9.3% and 4.9% of the total word number respectively). Analysis revealed that 14% of the abbreviations from medical ward documents were graded as ambiguous or unknown by medical senior physicians compared with 25% by senior orthopedic surgeons. When abbreviations from orthopedic surgery documents were presented to both groups, senior orthopedic surgeons graded 8% as ambiguous or unknown compared with 21% by the medical senior physicians.

CONCLUSION

In order to prevent impairment of patient care, only standard abbreviations should be used in medical documents. Measures should be taken to decrease the use of non standard abbreviations such as the incorporation of authorized abbreviations to the electronic medical record.

Patient Handoff Education: Are Medical Schools Catching Up?

Communication errors during shift-to-shift handoffs are a leading cause of preventable adverse events. Nevertheless, handoff skills are variably taught at medical schools. The authors administered questionnaires on handoffs to interns during orientation. Questions focused on medical school handoff education, experiences, and perceptions. The majority (546/718) reported having some form of education on handoffs during medical school, with 48% indicating this was 1 hour or less. Most respondents (98%) reported that they believe patients experience adverse events because of inadequate handoffs, and more than one third had witnessed a patient safety issue. Results show that medical school graduates are not receiving adequate handoff training. Yet graduates are expected to conduct safe patient handoffs at the start of residency. Given that ineffective handoffs pose a significant patient safety risk, medical school graduates should have a baseline competency in handoff skills. This will require medical schools to develop, implement, and study handoff education.

Shoulder Dystocia and Neonatal Resuscitation: An Integrated Obstetrics and Neonatology Simulation Case for Medical Students

INTRODUCTION

The new model in medical education of longitudinal clinical clerkships can be complemented by high-technology simulation, which provides a safe space for learners to consolidate clinical knowledge and practice decision-making skills, teamwork, and communication. We developed an interdisciplinary training intervention including a simulation case and structured debriefing to link clinical content between pediatrics and obstetrics at a major academic medical center.

METHODS

In this case, a 38-year-old female at 38 weeks gestation presents with onset of labor complicated by shoulder dystocia. After the appropriate maneuvers, a depressed neonate is delivered and requires resuscitation. Major equipment needed includes a high- or low-technology birthing mannequin and an infant mannequin.

RESULTS

Fifty-four third-year medical students participated in this simulation-based intervention at the completion of their integrated pediatrics and obstetrics clerkship. Ninety-one percent of students agreed that the shoulder dystocia simulation was designed appropriately for their learning level and enhanced their ability to handle a risky delivery. Ninety-four percent agreed that the neonatal resuscitation simulation was designed appropriately for their learning level, and 89% reported an enhanced ability to handle a similar situation in the clinic following the intervention. The average overall ratings were 4.24 (SD = 0.61) and 4.06 (SD = 0.89) on a 5-point scale (1 = poor, 5 = excellent) for the obstetrics and pediatrics simulations, respectively.

DISCUSSION

The integrated obstetrics and pediatrics scenario is feasible to run and clinically accurate. Two distinct areas of medicine in the third-year curriculum are logically incorporated into one cohesive simulation-based training intervention that students found positive and realistic.

Running Memory for Clinical Handoffs: A Look at Active and Passive Processing

OBJECTIVE

The goal of the present study was to examine the effects of domain-relevant expertise on running memory and the ability to process handoffs of information. In addition, the role of active or passive processing was examined.

BACKGROUND

Currently, there is little research that addresses how individuals with different levels of expertise process information in running memory when the information is needed to perform a real-world task.

METHOD

Three groups of participants differing in their level of clinical expertise (novice, intermediate, and expert) performed an abstract running memory span task and two tasks resembling real-world activities, a clinical handoff task and an air traffic control (ATC) handoff task. For all tasks, list length and the amount of information to be recalled were manipulated.

RESULTS

Regarding processing strategy, all participants used passive processing for the running memory span and ATC tasks. The novices also used passive processing for the clinical task. The experts, however, appeared to use more active processing, and the intermediates fell in between.

CONCLUSION

Overall, the results indicated that individuals with clinical expertise and a developed mental model rely more on active processing of incoming information for the clinical task while individuals with little or no knowledge rely on passive processing.

APPLICATION

The results have implications about how training should be developed to aid less experienced personnel identify what information should be included in a handoff and what should not.

Teaching Patient Handoffs to Medical Students in Obstetrics and Gynecology: Simulation Curriculum and Assessment Tool

INTRODUCTION

Patient handoffs, the communications required for the safe transfer of patient care, are known to be a common source of medical errors. Simulation exercises are effective techniques for teaching the procedures and patient interaction skills involved in a handoff. We developed a teaching tool that allows students to individually interact with a simulated patient, develop a treatment plan, and practice a handoff to another provider.

METHODS

The curriculum is a flexible instructional tool to teach patient handoffs in the context of a simulated obstetric emergency for learners at the clerkship through first-year obstetrics and gynecology resident levels. The curriculum secondarily teaches management of first-trimester bleeding with acute blood loss and can be adapted to allow advanced learners to practice obtaining informed consent. To evaluate this simulation for educational effectiveness, we developed a faculty observation assessment tool.

RESULTS

The simulation assessments for history taking, fund of knowledge, and interpersonal skills were predictive of subsequent clerkship clinical grades. Eighty percent of students agreed the exercise was realistic, 95% agreed it was relevant to the clinical curriculum, 90% agreed the simulation taught handoff skills, and 73% agreed the simulation increased confidence in handoff skills. Students uniformly found the curriculum to be relevant, realistic, and effective at teaching handoff skills.

DISCUSSION

Use of this curriculum has the potential to improve students' communication skills, handoff performance, and confidence during an obstetrics and gynecology clerkship. The assessment tool may allow early identification of students in need of improvement in communication skills.

Tools for structured team communication in pre-registration health professions education: a Best Evidence Medical Education (BEME) review: BEME Guide No. 41

INTRODUCTION

Calls for the inclusion of standardized protocols for information exchange into pre-registration health professions curricula have accompanied their introduction into clinical practice. In order to help clinical educators respond to these calls, we have reviewed educational interventions for pre-registration students that incorporate one or more of these ?tools for structured communication?.

METHODS

Searches of 10 databases (1990?2014) were supplemented by hand searches and by citation searches (to January 2015). Studies evaluating an intervention for pre-registration students of any clinical profession and incorporating at least one tool were included. Quality of included studies was assessed using a checklist of 11 indicators and a narrative synthesis of findings undertaken.

RESULTS

Fifty studies met our inclusion criteria. Of these, 21 evaluated the specific effect of a tool on educational outcomes, and 27 met seven or more quality indicators.

CONCLUSIONS

Pre-registration students, particularly those in the US, are learning to use tools for structured communication either in specific sessions or integrated into more extensive courses or programmes; mostly 'Situation Background Assessment Recommendation' and its variants. There is some evidence that learning to use a tool can improve the clarity and comprehensiveness of student communication, their perceived self-confidence and their sense of preparedness for clinical practice. There is, as yet, little evidence for the transfer of these skills to the clinical setting or for any influence of teaching approach on learning outcomes. Educators will need to consider the positioning of such learning with other skills such as clinical reasoning and decision-making.

Effect of handoff skills training for students during the medicine clerkship: a quasi-randomized study

Continuity is critical for safe patient care and its absence is associated with adverse outcomes. Continuity requires handoffs between physicians, but most published studies of educational interventions to improve handoffs have focused primarily on residents, despite interns expected to being proficient. The AAMC core entrustable activities for graduating medical students includes handoffs as a milestone, but no controlled studies with students have assessed the impact of training in handoff skills. The purpose of this study was to assess the impact of an educational intervention to improve third-year medical student handoff skills, the durability of learned skills into the fourth year, and the transfer of skills from the simulated setting to the clinical environment. Trained evaluators used standardized patient cases and an observation tool to assess verbal handoff skills immediately post intervention and during the student's fourth-year acting internship. Students were also observed doing real time sign-outs during their acting internship. Evaluators assessed untrained control students using a standardized case and performing a real-time sign-out. Intervention students mean score demonstrated improvement in handoff skills immediately after the workshop (2.6-3.8; p < 0.0001) that persisted into their fourth year acting internship when compared to baseline performance (3.9-3.5; p = 0.06) and to untrained control students (3.5 vs. 2.5; p < 0.001, d = 1.2). Intervention students evaluated in the clinical setting also scored higher than control students when assessed doing real-time handoffs (3.8 vs. 3.3; p = 0.032, d = 0.71). These findings should be useful to others considering introducing handoff teaching in the undergraduate medical curriculum in preparation for post-graduate medical training. Trial Registration Number NCT02217241.

Establishing a conceptual framework for handoffs using communication theory

BACKGROUND

A significant consequence of the 2003 Accreditation Council for Graduate Medical Education duty hour restrictions has been the dramatic increase in patient care handoffs. Ineffective handoffs have been identified as the third most common cause of medical error. However, research into health care handoffs lacks a unifying foundational structure. We sought to identify a conceptual framework that could be used to critically analyze handoffs.

METHODS

A scholarly review focusing on communication theory as a possible conceptual framework for handoffs was conducted. A PubMed search of published handoff research was also performed, and the literature was analyzed and matched to the most relevant theory for health care handoff models.

RESULTS

The Shannon-Weaver Linear Model of Communication was identified as the most appropriate conceptual framework for health care handoffs. The Linear Model describes communication as a linear process. A source encodes a message into a signal, the signal is sent through a channel, and the signal is decoded back into a message at the destination, all in the presence of internal and external noise. The Linear Model identifies 3 separate instances in handoff communication where error occurs: the transmitter (message encoding), channel, and receiver (signal decoding).

CONCLUSIONS

The Linear Model of Communication is a suitable conceptual framework for handoff research and provides a structured approach for describing handoff variables. We propose the Linear Model should be used as a foundation for further research into interventions to improve health care handoffs.

Medical school handoff education improves postgraduate trainee performance and confidence

OBJECTIVES

Determine postgraduate first-year (PGY-1) trainees ability to perform patient care handoffs and associated medical school training.

METHODS

About 173 incoming PGY-1 trainees completed an OSCE handoff station and a survey eliciting their training and confidence in conducting handoffs. Independent t-tests compared OSCE performance of trainees who reported receiving handoff training to those who had not. Analysis of variance examined differences in performance based on prior handoff instruction and across levels of self-assessed abilities, with significance set at p<0.05.

RESULTS

About 35% of trainees reported receiving instruction and 51% reported receiving feedback about their handoff performance in medical school. Mean handoff performance score was 69.5%. Trainees who received instruction or feedback during medical school had higher total and component handoff performance scores (p<0.05); they were also more confident in their handoff abilities (p<0.001). Trainees with higher self-assessed skills and preparedness performed better on the OSCE (p<0.05).

CONCLUSIONS

This study provides evidence that incoming trainees are not well prepared to perform handoffs. However, those who received instruction during medical school perform better and are more confident on standardized performance assessments. Given communication failures lead to uncertainty in patient care and increases in medical errors, medical schools should incorporate handoff training as required instruction.

SOUND: a structured handoff tool improves patient handoffs in a pediatric emergency department

INTRODUCTION

Handoff communication is an important contributor to safety and quality in the emergency department (ED). Breakdowns in this process may lead to unsafe conditions or adverse events. The purpose of this study was to test the hypothesis that the quality of patient handoffs in the pediatric ED would improve after implementation of a structured handoff method.

METHODS

In this prospective, observational study, we evaluated the implementation of a structured handoff tool, SOUND, which we developed to standardize the format of handoffs. The tool contains 5 components as follows: Synthesis, Objective Data, Upcoming Tasks, Nursing Input, and Double Check. SOUND was implemented through an online module and provider education. Handoffs were observed before and after implementation of SOUND. Statistical process control was used to measure the effects of the intervention. A successful handoff was defined as one in which 4 of the 5 components were included. As a balancing measure, we calculated mean time per handoff.

RESULTS

We observed 638 handoffs. The implementation of SOUND significantly increased the percentage of successful handoffs. Statistical process control demonstrated continued improvement over time. This improvement was associated with a modest increase in the mean time per patient discussed (52.9 vs 73.0 seconds, P < 0.01).

CONCLUSIONS

It is feasible to standardize patient handoffs in the pediatric ED. The implementation of SOUND improved completeness of handoffs with only a modest increase in the mean time spent discussing each patient. Future study is required to determine if SOUND will prove effective in other ED settings.

Handoff practices in undergraduate medical education

BACKGROUND

Growing data demonstrate that inaccuracies are prevalent in current handoff practices, and that these inaccuracies contribute to medical errors. In response, the Accreditation Council for Graduate Medical Education (ACGME) now requires residency programs to monitor and assess resident competence in handoff communication. Given these changes, undergraduate medical education programs must adapt to these patient safety concerns.

OBJECTIVES

To obtain up-to-date information regarding educational practices for medical students, the authors conducted a national survey of Clerkship Directors in Internal Medicine (CDIM) members.

DESIGN AND PARTICIPANTS

In June 2012, CDIM surveyed its institutional members, representing 121 of 143 Departments of Medicine in the U.S. and Canada. The section on handoffs included 12 questions designed to define the handoff education and practices of third year clerkship and fourth year sub-internship students.

KEY RESULTS

Ninety-nine institutional CDIM members responded (82%). The minority (15%) reported a structured handoff curriculum provided during the internal medicine (IM) core clerkship, and only 37% reported a structured handoff curriculum during the IM sub-internship. Sixty-six percent stated that third year students do not perform handoff activities. However, most respondents (93%) reported that fourth year sub-internship students perform patient handoff activities. Only twenty-six (26%) institutional educators in CDIM believe their current handoff curriculum is adequate.

CONCLUSIONS

Despite the growing literature linking poor handoffs to adverse events, few medical students are taught this competency during medical school. The common practice of allowing untrained sub-interns to perform handoffs as part of a required clerkship raises safety concerns. Evidence-based education programs are needed for handoff training.

Clinical clerkship students' perceptions of (un)safe transitions for every patient

PURPOSE

As calls for training and accreditation standards around improved patient care transitions have recently increased, more publications describing medical student education programs on care transitions have appeared. However, descriptions of students' experience with care transitions and the sender/receiver communication that supports or inhibits them are limited. To fill this gap, the authors developed this project to understand students' experiences with and perceptions of care transitions.

METHOD

At the start of a patient safety intersession at the Medical College of Wisconsin (2010), 193 third-year medical students anonymously wrote descriptions of critical incidents related to care transitions they had witnessed that evoked a strong emotional reaction. Descriptions included the emotion evoked, clinical context, and types of information exchanged. The authors analyzed the incident descriptions using a constant comparative qualitative methodology.

RESULTS

Analysis revealed that 111 of the 121 medical students (92%) who disclosed emotional responses had strong negative reactions to unsuccessful transitions, experiencing frustration, irritation, fear, and anger. All of these negative emotions were associated with lack of or poor communication between the sender and receiver: ambiguous roles and responsibilities, insufficient detailing of the patient's medical course, inadequate identification of the people involved in the transition, incomplete delineation of what the patient needed, and unclear reasons for the transition.

CONCLUSIONS

Third-year medical students' descriptions of care-transition incidents reveal high rates of strong negative emotions and of communication gaps that may adversely affect patient care. Results support curricular innovations that align students' needs and experiences with safe patient care transitions.

Addressing the Mandate for Hand-off Education

The Accreditation Council for Graduate Medical Education requires that residency programs teach residents about handoffs and ensure their competence in this communication skill. Development of hand-off curricula for anesthesia residency programs is hindered by the paucity of evidence regarding how to conduct, teach, and evaluate handoffs in the various settings where anesthesia practitioners work. This narrative review draws from literature in anesthesia and other disciplines to provide recommendations for anesthesia resident hand-off curriculum development and evaluation.

Participation and experience of third-year medical students in handoffs: time to sign out?

BACKGROUND

Although interns are expected to be competent in handoff communication, it is currently unclear what level of exposure, participation, and comfort medical students have with handoffs prior to graduation.

OBJECTIVE

The aim of this study is to characterize passive and active involvement of third-year medical students in the major components of the handoff process.

DESIGN

An anonymous voluntary retrospective cross-sectional survey administered in 2010.

PARTICIPANTS

Rising fourth-year students at two large urban private medical schools.

MAIN MEASURES

Participation and confidence in active and passive behaviors related to written signout and verbal handoffs during participants' third-year clerkships.

KEY RESULTS

Seventy percent of students (n = 204) responded. As third-year medical students, they reported frequent participation in handoffs, such as updating a written signout for a previously admitted patient (58 %). Students who reported frequent participation (at least weekly) in handoff tasks were more likely to report being confident in that task (e.g., giving verbal handoff 62 % vs. 19 %, p < 0.001). Students at one site that did not have a handoff policy for medical students reported greater participation, more confidence, and less desire for training. Nearly all students believed they had witnessed an error in written signout (98 %) and almost two-thirds witnessed an error due to verbal handoffs (64 %).

CONCLUSIONS

During their third year, many medical students are participating in handoffs, although reported rates differ across training environments. Medical schools should consider the appropriate level of competence for medical student participation in handoffs, and implement corresponding curricula and assessment tools to ensure that medical students are able to effectively conduct handoffs.

Investigating the scope of resident patient care handoffs within neurosurgery

INTRODUCTION

Handoffs are defined as verbal and written communications during patient care transitions. With the passage of recent ACMGE work hour rules further limiting the hours interns can spend in the hospital, many fear that more handoffs will occur, putting patient safety at risk. The issue of handoffs has not been studied in the neurosurgical literature.

METHODS

A validated, 20-question online-survey was sent to neurosurgical residents in all 98 accredited U.S. neurosurgery programs. Survey results were analyzed using tabulations.

RESULTS

449 surveys were completed yielding a 56% response rate. 63% of neurosurgical residents surveyed had not received formal instruction in what constitutes an effective handoff; 24% believe there is high to moderate variability among their co-residents in terms of the quality of the handoff provided; 55% experience three or more interruptions during handoffs on average. 90% of neurosurgical residents surveyed say that handoff most often occurs in a quiet, private area and 56% report a high level of comfort for knowing the potential acute, critical issues affecting a patient when receiving a handoff.

CONCLUSIONS

There needs to be more focused education devoted to learning effective patient-care handoffs in neurosurgical training programs. Increasingly, handing off a patient adequately and safely is becoming a required skill of residency.

Handoffs in the era of duty hours reform: a focused review and strategy to address changes in the Accreditation Council for Graduate Medical Education Common Program Requirements

With changes in the Accreditation Council for Graduate Medical Education (ACGME) Common Program Requirements related to transitions in care effective July 1, 2011, sponsoring institutions and training programs must develop a common structure for transitions in care as well as comprehensive curricula to teach and evaluate patient handoffs. In response to these changes, within the Duke University Health System, the resident-led Graduate Medical Education Patient Safety and Quality Council performed a focused review of the handoffs literature and developed a plan for comprehensive handoff education and evaluation for residents and fellows at Duke. The authors present the results of their focused review, concentrating on the three areas of new ACGME expectations--structure, education, and evaluation--and describe how their findings informed the broader initiative to comprehensively address transitions in care managed by residents and fellows. The process of developing both institution-level and program-level initiatives is reviewed, including the development of an interdisciplinary minimal data set for handoff core content, training and education programs, and an evaluation strategy. The authors believe the final plan fully addresses both Duke's internal goals and the revised ACGME Common Program Requirements and may serve as a model for other institutions to comprehensively address transitions in care and to incorporate resident and fellow leadership into a broad, health-system-level quality improvement initiative.