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

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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.

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We would like to thank the Academy of Distinguished Medical Educators at the University of Chicago Pritzker School of Medicine, which made this course possible. We would also like to thank Kris Slawinksi and Andy Bowyer for their technical assistance in the Clinical Performance Center. Finally, we would like to acknowledge our resident raters, Greg Behbehani, Keith Naylor, Bridget O’Brien, Tojo Thomas, Lavanaya Kondapalli, Adam Stein, Vagish Hemmige and Julie Kleczek.

Funding provided by the University of Chicago Pritzker School of Medicine Academy of Distinguished Medical Educators.

Drs. Arora and Farnan and funded by AHRQ 1 R03HS018278–01; Pritzker School of Medicine Academy of Distinguished Medical Educators and the University of Chicago Department of Medicine Medical Education and Clinical Excellence Award

Conflict of Interests

None disclosed.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Jeanne M. Farnan MD, MHPE.

Electronic Supplementary Materials

Below is the link to the electronic supplementary material.

Appendix A

OSHE student education teaching slides (PDF 799 kb)

Appendix B

Standardized Hand-off mock chart (PDF 30.7 kb)

Appendix C

OSHE training goals and objectives (PDF 21.3 kb)

Appendix D

Standardized written hand-off template (PDF 12.7 kb)

Appendix E

OSHE rater training slides (PDF 867 kb)

OSHE video can be viewed at]


Appendix 1: Hand-off CEX instrument

figure a

Appendix 2: Standardized Hand-off answer key

Table 2

Table 2 Standardized Hand-off Answer Key


Six-point identification data =1 point for each element in identification data

  • One for each element missed or incorrect

Four-point problem list

One point for one-line summary statement with why patient is here now

Three points for problem list, 1 point for each active problem with statement of management

Five points for complete medication list (all medications, all doses, all frequencies including PRN medications)

  • One point if missing over 50% doses

  • One point if missing over 50% of frequencies

  • One point if no PRN medications listed

Three points total for To Do:

  • One point for each To Do

Two points for If/Then Statement

Twenty points total

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Farnan, J.M., Paro, J.A.M., Rodriguez, R.M. et al. Hand-off Education and Evaluation: Piloting the Observed Simulated Hand-off Experience (OSHE). J GEN INTERN MED 25, 129–134 (2010).

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