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Development and Implementation of an Oral Sign-out Skills Curriculum

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Imperfect sign-out of patient information between providers has been shown to contribute to medical error, but there are no standardized curricula to teach sign-out skills. At our institution, we identified several deficiencies in skills and a lack of any existing training.


To develop a sign-out curriculum for medical house staff. Setting: Internal medicine residency program.

Program description

We developed a 1-h curriculum and implemented it in August of 2006 at three hospital sites. Teaching strategies included facilitated discussion, modeling, and observed individual practice with feedback. We emphasized interactive communication, a structured sign-out format summarized by an easy-to-remember mnemonic (“SIGNOUT”), consistent inclusion of key content items such as anticipatory guidance, and use of concrete language.

Program evaluation

We received 34 evaluations. The mean score for the course was 4.44 ± 0.61 on a 1–5 scale. Perceived usefulness of the structured oral communication format was 4.46 ± 0.78. Participants rated their comfort with providing oral sign-out significantly higher after the session than before (3.27 ± 1.0 before vs. 3.94 ± 0.90 after; p < .001).


We developed an oral sign-out curriculum that was brief, structured, and well received by participants. Further study is necessary to determine the long-term impact of the curriculum.

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Dr. Horwitz was supported by the Department of Veterans Affairs at the time this study was conducted. We thank Cyrus Kapadia, M.D., and Stephen J. Huot, M.D., Ph.D., directors of the categorical and primary care Internal Medicine residency programs, respectively, for their cooperation in implementing this curriculum. We also thank chief residents Francis W. Chan, M.D.; Caleb Moore, M.D.; Juliette Spelman, M.D.; and Matthew Stopper, M.D., for their assistance during the small-group sessions.

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Correspondence to Leora I. Horwitz MD, MHS.

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Horwitz, L.I., Moin, T. & Green, M.L. Development and Implementation of an Oral Sign-out Skills Curriculum. J GEN INTERN MED 22, 1470–1474 (2007).

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