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Handoff Practices in Undergraduate Medical Education

  • Original Research
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

ABSTRACT

BACKGROUND

Growing data demonstrate that inaccuracies are prevalent in current handoff practices, and that these inaccuracies contribute to medical errors. In response, the Accreditation Council for Graduate Medical Education (ACGME) now requires residency programs to monitor and assess resident competence in handoff communication. Given these changes, undergraduate medical education programs must adapt to these patient safety concerns.

OBJECTIVES

To obtain up-to-date information regarding educational practices for medical students, the authors conducted a national survey of Clerkship Directors in Internal Medicine (CDIM) members.

DESIGN AND PARTICIPANTS

In June 2012, CDIM surveyed its institutional members, representing 121 of 143 Departments of Medicine in the U.S. and Canada. The section on handoffs included 12 questions designed to define the handoff education and practices of third year clerkship and fourth year sub-internship students.

KEY RESULTS

Ninety-nine institutional CDIM members responded (82 %). The minority (15 %) reported a structured handoff curriculum provided during the internal medicine (IM) core clerkship, and only 37 % reported a structured handoff curriculum during the IM sub-internship. Sixty-six percent stated that third year students do not perform handoff activities. However, most respondents (93 %) reported that fourth year sub-internship students perform patient handoff activities. Only twenty-six (26 %) institutional educators in CDIM believe their current handoff curriculum is adequate.

CONCLUSIONS

Despite the growing literature linking poor handoffs to adverse events, few medical students are taught this competency during medical school. The common practice of allowing untrained sub-interns to perform handoffs as part of a required clerkship raises safety concerns. Evidence-based education programs are needed for handoff training.

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Acknowledgements

The data used in this survey is the property of the Clerkship Directors in Internal Medicine, and was used with permission. We would like to acknowledge the Alliance for Academic Internal Medicine staff for their help in creating an online survey, as well as in survey distribution, collection, and data entry. Portions of these data were presented as a poster at the Society of Hospital Medicine National Conference in National Harbor, MD, May 2013.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Author information

Authors and Affiliations

  1. Division of Hospital Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA

    Beth W. Liston MD, PhD, Kimberly M. Tartaglia MD & Curt Walker PhD

  2. Department of Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Daniel Evans MD

  3. Department of Internal Medicine, Drexel University College of Medicine, Philadelphia, PA, USA

    Dario Torre MD, PhD

Authors
  1. Beth W. Liston MD, PhD
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  2. Kimberly M. Tartaglia MD
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  3. Daniel Evans MD
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  4. Curt Walker PhD
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  5. Dario Torre MD, PhD
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Corresponding author

Correspondence to Beth W. Liston MD, PhD.

Appendix 1

Appendix 1

Handoffs

  • Is there a structured curriculum during the IM core clerkship on handoffs?

    1. a.

      Yes

    2. b.

      No

  • If yes, which of the following educational methods are used? Please check all that apply:

    1. a.

      Lecture

    2. b.

      Small group discussions

    3. c.

      Online curriculum

    4. d.

      Simulations

    5. e.

      Other (please specify)

  • Do third year core clerkship students perform any patient handoff activities (for example do they sign out their patients to the intern or sub-intern on call)?

    1. a.

      Yes

    2. b.

      No

  • If yes, in which activities? Please check all that apply:

    1. a.

      Structured verbal sign-out of patients at night

    2. b.

      Structured verbal sign-in of patients during the day

    3. c.

      Informal verbal sign-out of patients at night

    4. d.

      Informal verbal sign-in of patients during the day

    5. e.

      Clerkship students write sign-out notes

    6. f.

      Clerkship students write (or dictate) hospital discharge summaries

    7. g.

      Other (please specify)

  • Is there a structured curriculum during the IM sub-internship on handoffs?

    1. a.

      Yes

    2. b.

      No

  • If yes, which of the following educational methods are used? Please check all that apply:

    1. a.

      Lecture

    2. b.

      Small group discussions

    3. c.

      Online curriculum

    4. d.

      Simulations

    5. e.

      direct observation with feedback

    6. f.

      Other (please specify)

  • Do Sub-I students (4th year) perform patient handoff activities (for example do they sign out their patients to the intern, resident on call, or another sub-I student on call)?

    1. a.

      Yes

    2. b.

      No

  • If yes, in which activities? Please check all that apply:

    1. a.

      Structured verbal sign-out of patients at night

    2. b.

      Structured verbal sign-in of patients during the day

    3. c.

      Informal verbal sign-out of patients at night

    4. d.

      Informal verbal sign-in of patients during the day

    5. e.

      Clerkship students write sign-out notes

    6. f.

      Clerkship students write (or dictate) hospital discharge summaries

    7. g.

      Other (please specify)

  • Have formal curricular activities for 4th year sub-interns on handoffs changed at your school in the past two years?

    1. a.

      Yes

    2. b.

      No

    If yes, how have the requirements for 4th year sub-interns on handoffs changed? Please describe:

  • Do you intend to change the curriculum regarding handoffs in the IM core clerkship rotation in the near future?

    1. a.

      Yes

    2. b.

      No

    If yes, how do you intent to change the curriculum regarding handoffs? Please describe:

  • Do you believe that your current curriculum for medical students on handoffs is adequate?

    1. a.

      Yes

    2. b.

      No

    3. c.

      Not sure

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Liston, B.W., Tartaglia, K.M., Evans, D. et al. Handoff Practices in Undergraduate Medical Education. J GEN INTERN MED 29, 765–769 (2014). https://doi.org/10.1007/s11606-014-2806-0

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  • DOI: https://doi.org/10.1007/s11606-014-2806-0

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