The Intern Handover: the Gap Between Expectations and Performance

Abstract

The effective resident handover during transitions of patient care is a skill that is identified as one of the entrustable professional activities (EPAs) required for entering residency training. This study describes the results of an objective structured clinical exam (OSCE) station designed to assess interns’ skills in writing a handover of a standardized patient scenario. In 2015, 130 entering interns, representative of 47 of 125 allopathic medical schools, from 13 residency programs at the University of Florida participated in an OSCE that included a written handover station. A nine-item checklist was used to assess performance of interns on the station. Scores on the station ranged from 11.1 % (1 of 9 items correct) to 88.9 % (8 of 9 items correct). While there were no significant differences in handover performance between males and females or between surgical and non-surgical specialties, interns who graduated from top-50 medical schools performed better than graduates from the medical schools not ranked in the top 50. However, the overall failure rate on the handover station was 73 %. This study demonstrates that, despite the fact that the handover is an identified EPA, our interns did not enter residency with the skillset required to successfully demonstrate the required key components of a written patient handover. This demonstrates an undergraduate curricular need for the newly identified EPA that must be addressed.