Mitigating “Educational Groundhog Day” – The Role of Learner Handoffs Within Clinical Rotations: A Survey of Pediatric Educational Leaders

Abstract

BackgroundMedical students decry frequent changes in faculty supervision, leading to the experience of “educational groundhog day.” The discontinuity in supervision, cursory relationships, and uncoordinated feedback impede students’ skill acquisition and delay entrustment decisions. Whereas patient handoff bundles are common, little is known about similarly structured approaches to learner handoffs (LHs). ObjectiveTo describe current LH procedures and practices within pediatric clerkships and subinternships and to gauge interest in a future LH bundle. MethodsNine items included in the 2016 Council on Medical Student Education in Pediatrics annual member survey were analyzed using mixed-methods. ResultsThe response rates were 66% (101 of 152) and 40% (165 of 411) for institutions and individuals, respectively. After limiting data to complete responses to programs with traditional block rotations, 54% of individual respondents (76 of 141) identified as inpatient faculty and about a quarter endorsed providing LHs. Inpatient faculty most commonly supervise medical students for 5 to 7 days. Most endorsed needing 1 to 3 days to determine a student's baseline performance and 5 days or more to make entrustment decisions. Three-quarters of inpatient faculty endorsed interest in LHs, while fewer than 16% of course directors currently provide LH expectations. Four themes emerged: instrument features, stakeholder buy-in, impact, and utility. ConclusionsTypical inpatient faculty service days approximate the time required for making entrustment decisions about clinical students. While most inpatient faculty desire a LH bundle for use within a clinical rotation, few institutions and faculty currently use LHs. LHs could accelerate entrustment decisions by allowing coordinated feedback that might hasten learner clinical-skill development.