Journal of General Internal Medicine

, Volume 25, Issue 2, pp 129–134 | Cite as

Hand-off Education and Evaluation: Piloting the Observed Simulated Hand-off Experience (OSHE)

  • Jeanne M. Farnan
  • J. A. M. Paro
  • R. M. Rodriguez
  • S. T. Reddy
  • L. I. Horwitz
  • J. K. Johnson
  • V. M. Arora
Innovations in Education



The Observed Simulated Hand-off Experience (OSHE) was created to evaluate medical students’ sign-out skills using a real-time assessment tool, the Hand-off CEX.


Thirty-two 4th year medical students participated as part of an elective course.

Program description

One week following an interactive workshop where students learned effective hand-off strategies, students participated in an experience in which they performed a hand-off of a mock patient using simulated history and physical examination data and a brief video.

Program evaluation

Internal medicine residents served as standardized hand-off receivers and were trained on expectations. Students were provided feedback using a newly developed Hand-off CEX, based on the “Mini-CEX,” which rates overall hand-off performance and its components on a 9-point Likert-type scale. Outcomes included performance ratings and pre- and post-student self-assessments of hand-off preparedness. Data were analyzed using Wilcoxon signed-rank tests and descriptive statistics. Resident receivers rated overall student performance with a mean score of 6.75 (range 4–9, maximum 9). Statistically significant improvement was observed in self-perceived preparedness for performing an effective hand-off (67% post- vs. 27% pre-reporting ‘well-prepared,’ p < 0.009).


This brief, standardized hand-off training exercise improved students’ confidence and was rated highly by trained observers. Future work focuses on formal validation of the Hand-off CEX instrument.

Key Words

hand-offs simulation residency education 

Supplementary material

11606_2009_1170_MOESM1_ESM.pdf (800 kb)
Appendix AOSHE student education teaching slides (PDF 799 kb)
11606_2009_1170_MOESM2_ESM.pdf (31 kb)
Appendix BStandardized Hand-off mock chart (PDF 30.7 kb)
11606_2009_1170_MOESM3_ESM.pdf (21 kb)
Appendix COSHE training goals and objectives (PDF 21.3 kb)
11606_2009_1170_MOESM4_ESM.pdf (13 kb)
Appendix DStandardized written hand-off template (PDF 12.7 kb)
11606_2009_1170_MOESM5_ESM.pdf (867 kb)
Appendix EOSHE rater training slides (PDF 867 kb)


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Copyright information

© Society of General Internal Medicine 2009

Authors and Affiliations

  • Jeanne M. Farnan
    • 1
  • J. A. M. Paro
    • 3
  • R. M. Rodriguez
    • 3
  • S. T. Reddy
    • 1
    • 3
  • L. I. Horwitz
    • 4
  • J. K. Johnson
    • 5
  • V. M. Arora
    • 2
    • 3
  1. 1.Section of Hospital Medicine, Department of MedicineThe University of ChicagoChicagoUSA
  2. 2.Section of General Internal Medicine, Department of MedicineThe University of ChicagoChicagoUSA
  3. 3.The University of Chicago, Pritzker School of MedicineChicagoUSA
  4. 4.Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven CT; Section of General Internal Medicine, Department of MedicineYale University School of MedicineNew HavenUSA
  5. 5.Centre for Clinical Governance Research, Faculty of MedicineUniversity of New South WalesSydneyAustralia

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