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

Evaluating the Implementation of a Medical Student's Handoff Curriculum During the Surgery Clerkship

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.

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.

Vital Conversations: An Interactive Conflict Resolution Training Session for Fourth-Year Medical Students

INTRODUCTION

The AAMC has recognized the importance of effective teamwork and collaboration. One core Entrustable Professional Activity emphasizes creating a climate of mutual respect and trust and prioritizing team needs over personal needs, which leads to safe, timely, effective, efficient, and equitable patient care. Relationship conflicts, specifically, are associated with decreased productivity, complex information processing, and work satisfaction. Given the prevalence of conflict and its impact on health care workers, the lack of conflict resolution curricula in undergraduate medical education is surprising. We developed a curriculum formally introducing these skills and allowing practice in a simulated environment before students entered residency.

METHODS

Fourth-year medical students completed a conflict resolution exercise in a mandatory transition-to-residency course. Students completed online prework including reflection on teamwork and information on conflict resolution styles, participated in a simulated conflict with a standardized patient acting as a nurse, and afterward completed a self-evaluation with video review by the students' assigned coach and feedback on the session.

RESULTS

We collected complete responses from 108 students. We evaluated the curriculum for feasibility and acceptability by faculty and students. Most students agreed with faculty on their entrustment and milestone levels. Students found that the session prompted self-reflection and was a good review of conflict resolution. The standardized patient and faculty feedback was found to be the most useful by the students.

DISCUSSION

We successfully implemented a simulated but realistic conflict resolution exercise. Students found the exercise helpful in their preparation for residency.

Evaluation of a telemedicine-based training for final-year medical students including simulated patient consultations, documentation, and case presentation

Background: Focused history taking, knowledge-based clinical reasoning, and adequate case presentation during hand-offs represent important facets of competence of practicing physicians. Based on a validated 360-degree assessment simulating a first day of residency we developed a training for final-year medical students including patient consultation, patient management, and patient hand-off. Due to the COVID-19 pandemic the training was changed to a telemedicine format and evaluated. Methods: In 2019, 103 final-year students participated in a newly designed competence-based training including a consultation hour with simulated patients, a patient management phase with an electronic patient chart, and a case presentation in hand-off format. Due to social distancing regulations, the training was not allowed to take place in this way. Therefore, we changed the training to a telemedicine format. In May 2020, 32 students participated in the telemedicine training. A 5-point Likert scale (1: does not apply to 5: fully applies) was used for the evaluation items. The two formats were compared with t-tests. Results: The students were similarly satisfied with the content of the training independently of its format. Both groups found the patient cases interesting (presence: 4.68 ± 0.49, telemedicine: 4.66 ± 0.48). With respect to the telemedicine format, participants were glad that an option had been found that could be offered throughout the final year (4.94 ± 0.24) despite the COVID-19 pandemic and they regarded it as a very useful training for their final examination (4.94 ± 0.24). Conclusion: The telemedicine format of the competence-based training worked as well as the presence format. In its telemedicine format, the training can be offered to students independently of their location.