Abstract
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.
Highlights
In an effort to reduce errors associated with sleep deprivation, the Accreditation Council for Graduate Medical Education (ACGME) introduced resident duty hour regulations (Accreditation Council for Graduate Medical Education 2013)
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)
Sixty-five third-year medical students rotating on the inpatient medicine service from January 2012 to June 2012 were eligible for the pre-intervention group and 62 (95 %) agreed to participate
Summary
In an effort to reduce errors associated with sleep deprivation, the Accreditation Council for Graduate Medical Education (ACGME) introduced resident duty hour regulations (Accreditation Council for Graduate Medical Education 2013). There is evidence of negative consequences due to poor communication and information loss associated with inadequate handoffs (Sutcliffe et al 2004; Greenberg et al 2007; Gandhi et al 2006; Kachalia et al 2007). In response to these concerns, numerous national organizations, including the National Quality Forum (2010) and the Joint Commission (2007), have called for increased education about and more standardized approaches to patient care handoffs. The AAMC Core Entrustable Professional Activities for graduating medical students includes handoffs as a milestone (Aschenbrener et al 2014)
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