Association Between Hand-off Patients and Subject Exam Performance in Medicine Clerkship Students
- First Online:
- Cite this article as:
- Lang, V.J., Mooney, C.J., O’Connor, A.B. et al. J GEN INTERN MED (2009) 24: 1018. doi:10.1007/s11606-009-1045-2
- 70 Downloads
Teaching hospitals increasingly rely on transfers of patient care to another physician (hand-offs) to comply with duty hour restrictions. Little is known about the impact of hand-offs on medical students.
To evaluate the impact of hand-offs on the types of patients students see and the association with their subsequent Medicine Subject Exam performance.
Observational study over 1 year.
Third-year medical students in an Inpatient Medicine Clerkship at five hospitals with night float systems.
Primary outcome: Medicine Subject Exam at the end of the clerkship; explanatory variables: number of fresh (without prior evaluation) and hand-off patients, diagnoses, subspecialty patients, and full evaluations performed during the clerkship, and United Stated Medical Licensing Examination (USMLE) Step I scores.
Of the 2,288 patients followed by 89 students, 990 (43.3%) were hand-offs. In a linear regression model, the only variables significantly associated with students’ Subject Exam percentile rankings were USMLE Step I scores (B = 0.26, P < 0.001) and the number of full evaluations completed on fresh patients (B =0.20, P = 0.048; model r2 = 0.58). In other words, for each additional fresh patient evaluated, Subject Exam percentile rankings increased 0.2 points. For students in the highest quartile of Subject Exam percentile rankings, only Step I scores showed a significant association (B = 0.22, P = 0.002; r2 = 0.5). For students in the lowest quartile, only fresh patient evaluations demonstrated a significant association (B = 0.27, P = 0.03; r2 = 0.34).
Hand-offs constitute a substantial portion of students’ patients and may have less educational value than “fresh” patients, especially for lower performing students.