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Harendza S, Bacher HJ, Berberat PO, Kadmon M, Gärtner J. Implicit expression of uncertainty in medical students during different sequences of clinical reasoning in simulated patient handovers. GMS JOURNAL FOR MEDICAL EDUCATION 2023; 40:Doc7. [PMID: 36923315 PMCID: PMC10010770 DOI: 10.3205/zma001589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 08/19/2022] [Accepted: 11/23/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND Dealing with medical uncertainty is an essential competence of physicians. During handovers, communication of uncertainty is important for patient safety, but is often not explicitly expressed and can hamper medical decisions. This study examines medical students' implicit expression of uncertainty in different sequences of clinical reasoning during simulated patient handovers. METHODS In 2018, eighty-seven final-year medical students participated in handovers of three simulated patient cases, which were videotaped and transcribed verbatim. Sequences of clinical reasoning and language references to implicit uncertainty that attenuate and strengthen information based on a framework were identified, categorized, and analyzed with chi-square goodness-of-fit tests. RESULTS A total of 6358 sequences of clinical reasoning were associated with the four main categories "statement", "assessment", "consideration", and "implication", with statements occurring significantly (p<0.001) most frequently. Attenuated sequences of clinical reasoning occurred significantly (p<0.003) more frequently than strengthened sequences. Implications were significantly more often attenuated than strengthened (p<0.003). Statements regarding results occurred significantly more often plain or strengthened than statements regarding actions (p<0.0025). CONCLUSION Implicit expressions of uncertainty in simulated medical students' handovers occur in different degrees during clinical reasoning. These findings could contribute to courses on clinical case presentations by including linguistic terms and implicit expressions of uncertainty and making them explicit.
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Affiliation(s)
- Sigrid Harendza
- Universitätsklinikum Hamburg-Eppendorf, III. Medizinische Klinik, Hamburg, Germany
| | - Hans Jakob Bacher
- Universitätsklinikum Hamburg-Eppendorf, III. Medizinische Klinik, Hamburg, Germany
| | - Pascal O. Berberat
- Technische Universität München, Fakultät für Medizin, TUM Medical Education Center, München, Germany
| | - Martina Kadmon
- Universität Augsburg, Medizinische Fakultät, Dekanat, Augsburg, Germany
| | - Julia Gärtner
- Universitätsklinikum Hamburg-Eppendorf, III. Medizinische Klinik, Hamburg, Germany
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Evaluating the Implementation of a Medical Student's Handoff Curriculum During the Surgery Clerkship. J Surg Res 2023; 282:262-269. [PMID: 36332305 DOI: 10.1016/j.jss.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 08/17/2022] [Accepted: 10/08/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Early introduction to essential communication skills is important. We sought to determine if a handoff curriculum (HC) would improve confidence, decrease anxiety, and increase participation in clinical handoffs during the surgical clerkship. METHODS A multi-center prospective cohort study was performed at two medical schools. Training in the intervention group (HC) consisted of a didactic lecture, video review, and practice session. Students completed a pre-clerkship knowledge test and confidence/anxiety/handoff experience questionnaire pre- and post-clerkship. RESULTS There were no significant differences in pre-clerkship handoff experiences between institutions except having previously witnessed a verbal handoff (School A 96.4% versus School B 76.2%, P = 0.01). While there were no significant differences in post-clerkship confidence or anxiety, HC students were significantly more involved with written sign-outs (52.9% versus 18.2%, P = 0.02) and verbal handoffs (29.4% versus 4.6%, P = 0.03). CONCLUSIONS Medical students exposed to handoff training shared similar confidence and anxiety scores compared to those that were not, however, they were more involved in handoff experiences during their surgical clerkship. Early introduction to handoff skills may encourage greater participation during subsequent clinical experiences.
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Garber AM, Ownby AR, Trimble G, Aiyer MK, Brown DR, Grbic D. Evaluating the Association of a Core EPA-Oriented Patient Handover Curriculum on Medical Students' Self-reported Frequency of Observation and Skill Acquisition. MEDICAL SCIENCE EDUCATOR 2022; 32:855-864. [PMID: 36035537 PMCID: PMC9411269 DOI: 10.1007/s40670-022-01578-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/14/2022] [Indexed: 06/15/2023]
Abstract
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.
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Affiliation(s)
- Adam M. Garber
- Department of Internal Medicine, Virginia Commonwealth University School of Medicine, 1200 East Broad Street, PO Box 980102, Richmond, VA 23298-0102 USA
| | - Allison R. Ownby
- Office of Educational Programs, McGovern Medical School at UTHealth, Houston, TX USA
| | - Gregory Trimble
- Department of Internal Medicine, University of Virginia School of Medicine INOVA Campus, Fairfax, VA USA
| | - Meenakshy K. Aiyer
- Department of Internal Medicine, University of Illinois College of Medicine, Peoria, IL USA
| | - David R. Brown
- Division of Family and Community Medicine, Department of Humanities, Health, and Society, Florida International University Herbert Wertheim College of Medicine, Miami, FL USA
| | - Douglas Grbic
- Association of American Medical Colleges, Washington, DC USA
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Pinilla S, Lenouvel E, Cantisani A, Klöppel S, Strik W, Huwendiek S, Nissen C. Working with entrustable professional activities in clinical education in undergraduate medical education: a scoping review. BMC MEDICAL EDUCATION 2021; 21:172. [PMID: 33740970 PMCID: PMC7980680 DOI: 10.1186/s12909-021-02608-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 03/10/2021] [Indexed: 05/13/2023]
Abstract
BACKGROUND Entrustable professional activities (EPAs) are increasingly used in undergraduate medical education (UME). We conducted a scoping review to summarize the evidence for the use of EPAs in clinical rotations in UME. METHODS We searched multiple databases for scoping reviews based on the PRISMA guidelines for articles reporting qualitative and quantitative research, as well as conceptual and curriculum development reports, on EPAs in UME clinical rotations. RESULTS We identified 3309 records by searching through multiple databases. After the removal of duplicates, 1858 reports were screened. A total of 36 articles were used for data extraction. Of these, 47% reported on EPA and EPA-based curriculum development for clerkships, 50% reported on implementation strategies, and 53% reported on assessment methods and tools used in clerkships. Validity frameworks for developing EPAs in the context of clerkships were inconsistent. Several specialties reported feasible implementation strategies for EPA-based clerkship curricula, however, these required additional faculty time and resources. Limited exposure to clinical activities was identified as a barrier to relevant learning experiences. Educators used nationally defined, or specialty-specific EPAs, and a range of entrustability and supervision scales. We found only one study that used an empirical research approach for EPA assessment. One article reported on the earlier advancement of trainees from UME to graduate medical education based on summative entrustment decisions. CONCLUSIONS There is emerging evidence concerning how EPAs can be effectively introduced to clinical training in UME. Specialty-specific, nested EPAs with context-adapted, entrustment-supervision scales might be helpful in better leveraging their formative assessment potential.
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Affiliation(s)
- Severin Pinilla
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department for Assessment and Evaluation, Institute for Medical Education, University of Bern, Bern, Switzerland
| | - Eric Lenouvel
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Andrea Cantisani
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Stefan Klöppel
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Werner Strik
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Sören Huwendiek
- Department for Assessment and Evaluation, Institute for Medical Education, University of Bern, Bern, Switzerland
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
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Ashokka B, Dong C, Law LSC, Liaw SY, Chen FG, Samarasekera DD. A BEME systematic review of teaching interventions to equip medical students and residents in early recognition and prompt escalation of acute clinical deteriorations: BEME Guide No. 62. MEDICAL TEACHER 2020; 42:724-737. [PMID: 32493155 DOI: 10.1080/0142159x.2020.1763286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Background: Current educational interventions and teaching for acute deteriorations seem to address acute care learning in discreet segments. Technology enhanced and team training methodologies are in vogue though well studied in the nursing profession, teaching avenues for junior 'doctors in training' seem to be a lacuna.Aims: The BEME systematic review was designed to (1) appraise the existing published evidence on educational interventions that are intended for 'doctors in training' to teach early recognition and prompt escalation in acute clinical deteriorations (2) to synthesise evidence & to evaluate educational effectiveness.Methodology: The method applied was a descriptive, justification & clarification review. Databases searched included PubMed, PsycINFO, Science Direct and Scopus for original research and grey literature with no restrictions to year or language. Abstract review, full text decisions and data extraction were completed by two primary coders with final consensus by a third reviewer.Results: 5592 titles and abstracts were chosen after removal of 905 duplications. After exclusion of 5555 studies, 37 full text articles were chosen for coding. 22 studies met final criteria of educational effectiveness, relevance to acute care. Educational platforms varied from didactics to blended learning approaches, small group teaching sessions, simulations, live & cadaveric tissue training, virtual environments and insitu team-based training. Translational outcomes with reduction in long term (up to 3-6 years) morbidity & mortality with financial savings were reported by 18% (4/22) studies. Interprofessional training were reported in 41% (9/22) of studies. Recent evidence demonstrated effectiveness of virtual environment and mobile game-based learning.Conclusions: There were significant improvements in teaching initiatives with focus on observable behaviours and translational real patient outcomes. Serious game-based learning and virtual multi-user collaborative environments might enhance individual learners' cognitive deliberate practice. Acute care learning continuum with programmatic acute care portfolios could be a promise of the future.
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Affiliation(s)
| | | | | | - Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore
| | - Fun Gee Chen
- Anaesthesia, National University of Singapore, Singapore
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[Implementation and evaluation of a revised curriculum for psychiatry and psychotherapy]. DER NERVENARZT 2019; 90:1170-1176. [PMID: 30694367 DOI: 10.1007/s00115-019-0677-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Medical education in the discipline of psychiatry and psychotherapy at the University of Münster was traditionally focused on the transfer of knowledge via lectures. According to the current guidelines, the medical curriculum was modified as from the winter semester 2016/2017 to be more competency-based and the changes were evaluated. OBJECTIVE Lectures and seminars were reduced to achieve a better linkage between theoretical and practical knowledge. Moreover, learning goals were formulated based on the German National Competence-based Catalogue of Learning Objectives in Medicine (NKLM) and entrustable professional activities (EPAs). MATERIAL AND METHODS Almost all previous lectures are now replaced by an inverted classroom concept with e‑learning. Theoretical knowledge is deepened by immediate multiple choice (MC) examinations and a seminar, which now focusses on specific practical EPAs. At the end of the semester, the students now undergo a practical, formative examination with simulated patients (actors) in addition to the former MC test. For evaluation, a representative sample of a semester cohort which took part in the previous curriculum and a similar cohort which attended the revised curriculum were investigated. Moreover, variables which might have an impact on the results were assessed, e. g. pre-existing psychiatric knowledge and motivation. RESULTS Students taught by the modified curriculum showed a significantly better practical performance and no reduction of theoretical knowledge. Relevant influencing factors were not identified. CONCLUSION The results show that a competency-based modification of the curriculum in the discipline of psychiatry and psychotherapy leads to more practical abilities and thus helps future physicians to be more self-determined.
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Hinding B, Deis N, Gornostayeva M, Götz C, Jünger J. Patient handover - the poor relation of medical training? GMS JOURNAL FOR MEDICAL EDUCATION 2019; 36:Doc19. [PMID: 30993177 PMCID: PMC6446468 DOI: 10.3205/zma001227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 09/17/2018] [Accepted: 09/25/2018] [Indexed: 06/09/2023]
Abstract
Objective: The handover of patients to medical colleagues and to members of other professional groups is a central task in the medical care process for patient safety. Nevertheless, little is known about teaching and testing on the subject of handing over. The present article therefore examines the extent to which handover is the subject of teaching and examinations at medical faculties in Germany. Methodology: In 31 medical faculties the teachers were asked about the implementation of the NKLM learning objectives in the area of communication. The survey was conducted within the framework of group interviews with lecturers, in which it was determined whether each learning objective of the NKLM (National Competency-based Catalogue of Learning Objectives in Medicine) on the subject of communication, is explicitly taught in lectures and examinations at the respective faculty. Results: The learning objective "transfer to medical colleagues" is covered by 19 faculties, while the learning objective of interprofessional transfer is covered by 14 faculties. There are examinations for transfer to medical colleagues and interprofessional transfer at two faculties. There is a highly significant relationship between the total number of communicative learning objectives that are put into practice in a faculty and the coverage of the learning objectives for handover. Conclusions: In the field of communications, the subject of handover is less frequently taught at the faculties and, more importantly, it is less frequently examined than other NKLM contents. This is particularly evident in the interprofessional area. The subject is more likely to be taught as a handover between physicians, while the interprofessional interfaces attract less attention. In terms of patient safety, it would be desirable to give a higher priority to the subject of handover. An inter-faculty exchange and the inclusion of the subject of intra- and interprofessional transfer in state examinations could give the implementation process at the faculties a decisive impetus.
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Affiliation(s)
- Barbara Hinding
- The German National Institute for state examinations in Medicine, Pharmacy and Psychotherapy, Mainz, Germany
| | - Nicole Deis
- The German National Institute for state examinations in Medicine, Pharmacy and Psychotherapy, Mainz, Germany
| | - Maryna Gornostayeva
- The German National Institute for state examinations in Medicine, Pharmacy and Psychotherapy, Mainz, Germany
| | - Christian Götz
- The German National Institute for state examinations in Medicine, Pharmacy and Psychotherapy, Mainz, Germany
| | - Jana Jünger
- The German National Institute for state examinations in Medicine, Pharmacy and Psychotherapy, Mainz, Germany
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Exploring the extent to which simulation-based education addresses contemporary patient safety priorities: A scoping review. Collegian 2019. [DOI: 10.1016/j.colegn.2018.04.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Thaeter L, Schröder H, Henze L, Butte J, Henn P, Rossaint R, Sopka S. Handover training for medical students: a controlled educational trial of a pilot curriculum in Germany. BMJ Open 2018; 8:e021202. [PMID: 30209154 PMCID: PMC6144335 DOI: 10.1136/bmjopen-2017-021202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 06/29/2018] [Accepted: 07/17/2018] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE The aim of this study was to implement and evaluate a newly developed standardised handover curriculum for medical students. We sought to assess its effect on students' awareness, confidence and knowledge regarding handover. DESIGN A controlled educational research study. SETTING The pilot handover training curriculum was integrated into a curriculum led by the Departments of Anesthesiology and Intensive Care (AI) at the University Hospital. It consisted of three modules integrated into a 4-week course of AI. Multiple types of handover settings namely end-of-shift, operating room/postanaesthesia recovery unit, intensive care unit, telephone and discharge were addressed. PARTICIPANTS A total of n=147 fourth-year medical students participated in this study, who received either the current standard existing curriculum (no teaching of handover, n=78) or the curriculum that incorporated the pilot handover training (n=69). OUTCOME MEASURES Paper-based questionnaires regarding attitude, confidence and knowledge towards handover and patient safety were used for pre-assessment and post-assessment. RESULTS Students showed a significant increase in knowledge (p<0.01) and self-confidence for the use of standardised handover tools (p<0.01) as well as accurate handover performance (p<0.01) among the pilot group. CONCLUSION We implemented and evaluated a pilot curriculum for undergraduate handover training. Students displayed a significant increase in knowledge and self-confidence for the use of standardised handover tools and accuracy in handover performance. Further studies should evaluate whether the observed effect is sustained across time and is associated with patient benefit.
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Affiliation(s)
- Laura Thaeter
- Anesthesiology Clinic, University Hospital Aachen, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Aachen Interdisciplinary Training Center for Medical Education, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Hanna Schröder
- Anesthesiology Clinic, University Hospital Aachen, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Aachen Interdisciplinary Training Center for Medical Education, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Lina Henze
- Aachen Interdisciplinary Training Center for Medical Education, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Jennifer Butte
- Anesthesiology Clinic, University Hospital Aachen, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Patrick Henn
- School of Medicine, University College Cork, Cork, Ireland
| | - Rolf Rossaint
- Anesthesiology Clinic, University Hospital Aachen, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Saša Sopka
- Anesthesiology Clinic, University Hospital Aachen, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Aachen Interdisciplinary Training Center for Medical Education, Medical Faculty, RWTH Aachen University, Aachen, Germany
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Gordon M, Hill E, Stojan JN, Daniel M. Educational Interventions to Improve Handover in Health Care: An Updated Systematic Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:1234-1244. [PMID: 29620675 PMCID: PMC6092095 DOI: 10.1097/acm.0000000000002236] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
PURPOSE Effective handovers (handoffs) are vital to patient safety. Medical educators investigated educational interventions to improve handovers in a 2011 systematic review. The number of publications on handover education has increased since then, so authors undertook this updated review. METHOD The authors considered studies involving educational interventions to improve handover amongst undergraduate or postgraduate health professionals in acute care settings. In September 2016, two authors independently conducted a standardized search of online databases and completed a data extraction and quality assessment of the articles included. They conducted a content analysis of and extracted key themes from the interventions described. RESULTS Eighteen reports met the inclusion criteria. All but two were based in the United States. Interventions most commonly involved single-patient exercises based on simulation and role-play. Many studies mentioned multiprofessional education or practice, but interventions occurred largely in single-professional contexts. Analysis of interventions revealed three major themes: facilitating information management, reducing the potential for errors, and improving confidence. The majority of studies assessed Kirkpatrick's outcomes of satisfaction and knowledge/skill improvement (Levels 1 and 2). The strength of conclusions was generally weak. CONCLUSIONS Despite increased interest in and publications on handover, the quality of published research remains poor. Inadequate reporting of interventions, especially as they relate to educational theory, pedagogy, curricula, and resource requirements, continues to impede replication. Weaknesses in methodologies, length of follow-up, and scope of outcomes evaluation (Kirkpatrick levels) persist. Future work to address these issues, and to consider the role of multiprofessional and multiple-patient handovers, is vital.
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Affiliation(s)
- Morris Gordon
- M. Gordon is professor of evidence synthesis and systematic review, University of Central Lancashire, Preston, United Kingdom; ORCID: https://orcid.org/0000-0002-1216-5158
| | - Elaine Hill
- E. Hill is senior lecturer, School of Health Sciences, University of Central Lancashire, Preston, United Kingdom; ORCID: http://orcid.org/0000-0003-4984-9446
| | - Jennifer N. Stojan
- J.N. Stojan is assistant professor, Department of Internal Medicine and Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan
| | - Michelle Daniel
- M. Daniel is assistant dean for curriculum and assistant professor, Department of Emergency Medicine and Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: http://orcid.org/0000-0001-8961-7119
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Friend K, Hook L, Joshi AR. Improving Information Transfer during Transitions of Care via Standardized Handoffs. Am Surg 2018. [DOI: 10.1177/000313481808400732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Multiple studies have shown the detrimental effect of miscommunication during transitions of care. The aim of this study is to determine whether a certain method of “sign-out” can improve information transmission and thereby reduce medical errors. Surgical interns underwent a 90-minute training session before starting residency in five previously verified methods of sign-out. They were randomly assigned to six groups (five methods and a control group). They were then given seven simulated patient charts with varying levels of medical complexity. They were then instructed to “sign-out” the patients to randomly selected colleagues. The control group did not use any of the previously taught methods and passed on information in a manner of their choosing. None of the methods consistently results in excellent transitions of care. Patient information values ranged from 26 to 40 (depending on complexity). Major points were consistently missed by all methods, but this may have been a component of the time constraint placed on this study. The “SIGNOUT?” method resulted in superior data transmission when compared with the control group (P = 0.0401). The only method that seemed to be significantly inferior was the “9Ds” method (P = 0.0610). The “SIGNOUT?” method leads to the largest amount of relevant information transmitted to the incoming team. There was no statistically significant difference among the other methods. Improvement in “sign-out” modalities and training may improve transmission of relevant patient information, but larger studies are needed to verify the data seen in this small, single-site study.
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Affiliation(s)
- Kara Friend
- From the Department of Surgery, Einstein Healthcare Network, Philadelphia, Pennsylvania
| | - Lauren Hook
- From the Department of Surgery, Einstein Healthcare Network, Philadelphia, Pennsylvania
| | - Amit R.T. Joshi
- From the Department of Surgery, Einstein Healthcare Network, Philadelphia, Pennsylvania
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Davis R, Davis J, Berg K, Berg D, Morgan CJ, Russo S, Riesenberg LA. Patient Handoff Education: Are Medical Schools Catching Up? Am J Med Qual 2017; 33:140-146. [PMID: 28728430 DOI: 10.1177/1062860617719128] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Robyn Davis
- 1 The University of Alabama at Birmingham, AL
| | - Joshua Davis
- 2 Pennsylvania State College of Medicine, Hershey, PA
| | - Katherine Berg
- 3 Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Dale Berg
- 3 Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | | | - Stefani Russo
- 3 Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
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Alphonso A, Pathy S, Bruno C, Boeras C, Emerson B, Crabtree J, Johnston L, Desai V, Auerbach M. Shoulder Dystocia and Neonatal Resuscitation: An Integrated Obstetrics and Neonatology Simulation Case for Medical Students. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2017; 13:10594. [PMID: 30800796 PMCID: PMC6338204 DOI: 10.15766/mep_2374-8265.10594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 05/18/2017] [Indexed: 05/14/2023]
Abstract
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.
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Affiliation(s)
| | - Shefali Pathy
- Assistant Professor, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine
| | - Christie Bruno
- Assistant Professor, Pediatrics (Neonatology), Yale School of Medicine
| | - Crina Boeras
- Clinical Assistant Provider, Bridgeport Hospital
- Clinical Instructor, Department Of Obstetrics And Gynecology, Yale School of Medicine
| | - Beth Emerson
- Assistant Professor, Pediatric Emergency Medicine, Yale School of Medicine
| | - Janice Crabtree
- Manager of Medical Education, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine
| | - Lindsay Johnston
- Associate Professor of Pediatrics (Neonatology), Yale School of Medicine
| | - Vrunda Desai
- Assistant Professor, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine
| | - Marc Auerbach
- Associate Professor, Pediatrics and Emergency Medicine, Yale School of Medicine
- Director of Pediatric Simulation, Yale Center For Medical Simulation
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Jiang SY, Murphy A, Heitkemper EM, Hum RS, Kaufman DR, Mamykina L. Impact of an electronic handoff documentation tool on team shared mental models in pediatric critical care. J Biomed Inform 2017; 69:24-32. [PMID: 28286030 DOI: 10.1016/j.jbi.2017.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 02/27/2017] [Accepted: 03/06/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine the impact of the implementation of an electronic handoff tool (the Handoff Tool) on shared mental models (SMM) within patient care teams as measured by content overlap and discrepancies in verbal handoff presentations given by different clinicians caring for the same patient. MATERIALS AND METHODS Researchers observed, recorded, and transcribed verbal handoffs given by different members of patient care teams in a pediatric intensive care unit. The transcripts were qualitatively coded and analyzed for content overlap scores and the number of discrepancies in handoffs of different team members before and after the implementation of the tool. RESULTS Content overlap scores did not change post-implementation. The average number of discrepancies nearly doubled following the implementation (from 0.76 discrepancies per handoff group pre-implementation to 1.17 discrepancies per handoff group post-implementation); however, this change was not statistically significant (p=0.37). Discrepancies classified as related to dosage of treatment or procedure and to patients' symptoms increased in frequency post-implementation. DISCUSSION The results suggest that the Handoff Tool did not have the desired positive impact on SMM within patient care teams. Future electronic tools for facilitating team handoff may need longer implementation times, complementary changes to handoff process and structure, and improved designs that integrate a common core of shared information with discipline-specific records. CONCLUSION While electronic handoff tools provide great opportunities to improve communication and facilitate the formation of shared mental models within patient care teams, further work is necessary to realize their full potential.
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Affiliation(s)
- Silis Y Jiang
- Department of Biomedical Informatics, Columbia University, United States.
| | - Alexandrea Murphy
- Department of Biomedical Informatics, Columbia University, United States
| | | | - R Stanley Hum
- Department of Pediatrics, College of Physicians and Surgeons, Columbia University, United States
| | - David R Kaufman
- Department of Biomedical Informatics, Arizona State University, United States; Mayo Clinic Arizona, United States
| | - Lena Mamykina
- Department of Biomedical Informatics, Columbia University, United States
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Burns R, Adler M, Mangold K, Trainor J. A Brief Boot Camp for 4th-Year Medical Students Entering into Pediatric and Family Medicine Residencies. Cureus 2016; 8:e488. [PMID: 27014522 PMCID: PMC4786377 DOI: 10.7759/cureus.488] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The transition from medical student to intern is a challenging process characterized by a steep learning curve. Focused courses targeting skills necessary for success as a resident have increased self-perceived preparedness, confidence, and medical knowledge. Our aim was to create a brief educational intervention for 4th-year medical students entering pediatric, family practice, and medicine/pediatric residencies to target skills necessary for an internship. The curriculum used a combination of didactic presentations, small group discussions, role-playing, facilitated debriefing, and simulation-based education. Participants completed an objective structured clinical exam requiring synthesis and application of multiple boot camp elements before and after the elective. Participants completed anonymous surveys assessing self-perceived preparedness for an internship, overall and in regards to specific skills, before the elective and after the course. Participants were asked to provide feedback about the course. Using checklists to assess performance, students showed an improvement in performing infant lumbar punctures (47.2% vs 77.0%; p < 0.01, 95% CI for the difference 0.2, 0.4%) and providing signout (2.5 vs. 3.9 (5-point scale) p < 0.01, 95% CI for the difference 0.6, 2.3). They did not show an improvement in communication with a parent. Participants demonstrated an increase in self-reported preparedness for all targeted skills, except for obtaining consults and interprofessional communication. There was no increase in reported overall preparedness. All participants agreed with the statements, “The facilitators presented the material in an effective manner,” “I took away ideas I plan to implement in internship,” and “I think all students should participate in a similar experience.” When asked to assess the usefulness of individual modules, all except order writing received a mean Likert score > 4. A focused boot camp addressing key knowledge and skills required for pediatric-related residencies was well received and led to improved performance of targeted skills and increased self-reported preparedness in many targeted domains.
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Affiliation(s)
- Rebekah Burns
- Pediatrics, Seattle Children's Hospital - University of Washington School of Medicine
| | - Mark Adler
- Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Karen Mangold
- Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jennifer Trainor
- Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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