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Medical Science Educator

, Volume 26, Issue 4, pp 771–776 | Cite as

The Intern Handover: the Gap Between Expectations and Performance

  • Carolyn Stalvey
  • Julia Close
  • Merry Jennifer Markham
  • Lynne Meyer
  • Ying Nagoshi
  • Lou Ann Cooper
Original Research

Abstract

The effective resident handover during transitions of patient care is a skill that is identified as one of the entrustable professional activities (EPAs) required for entering residency training. This study describes the results of an objective structured clinical exam (OSCE) station designed to assess interns’ skills in writing a handover of a standardized patient scenario. In 2015, 130 entering interns, representative of 47 of 125 allopathic medical schools, from 13 residency programs at the University of Florida participated in an OSCE that included a written handover station. A nine-item checklist was used to assess performance of interns on the station. Scores on the station ranged from 11.1 % (1 of 9 items correct) to 88.9 % (8 of 9 items correct). While there were no significant differences in handover performance between males and females or between surgical and non-surgical specialties, interns who graduated from top-50 medical schools performed better than graduates from the medical schools not ranked in the top 50. However, the overall failure rate on the handover station was 73 %. This study demonstrates that, despite the fact that the handover is an identified EPA, our interns did not enter residency with the skillset required to successfully demonstrate the required key components of a written patient handover. This demonstrates an undergraduate curricular need for the newly identified EPA that must be addressed.

Keywords

Entrustable professional activities EPAs Handover Handoff Transitions of care Residency and internship Objective structured clinical examination Intern OSCE, clinical skills examination 

Notes

Acknowledgments

Staff of the Anaclerio Learning and Assessment Center, University of Florida College of Medicine, and Zareen Zaidi, MD, Department of Medicine, University of Florida College of Medicine

Compliance with Ethical Standards

Source of Funding

University of Florida, College of Medicine, Office of the Dean

References

  1. 1.
    Mulder H, ten Cate O, Daalder R, Berkvens J. Building a competency-based workplace curriculum around entrustable professional activities: the case of physician assistant training. Med Teach. 2010;32(10):e453–9.CrossRefGoogle Scholar
  2. 2.
    Core Entrustable Professional Activities for Entering Residency. 2014. https://www.mededportal.org/icollaborative/resource/887. Accessed 11 Jan 2016.
  3. 3.
    ten Cate O. Entrustability of professional activities and competency-based training. Med Educ. 2005;39:1176–7.CrossRefGoogle Scholar
  4. 4.
    ten Cate O, Young JQ. The patient handover as an entrustable professional activity: adding meaning in teaching and practice. BMJ Qual Saf. 2012;21(Suppl 1):i9–12.CrossRefGoogle Scholar
  5. 5.
    Starmer AJ, O’Toole JK, Rosenbluth G, Calaman S, Balmer D, West DC, et al. Development, implementation, and dissemination of the I-PASS handoff curriculum: a multisite educational intervention to improve patient handoffs. Acad Med. 2014;89(6):876–84.CrossRefGoogle Scholar
  6. 6.
    Starmer AJ, Spector ND, Srivastava R, West DC, Rosenbluth G, Allen AD, et al. Changes in medical errors after implementation of a handoff program. N Engl J Med. 2014;371(19):1803–12.CrossRefGoogle Scholar
  7. 7.
    Riesenberg LA, Leitzsch J, Little BW. Systematic review of handoff mnemonics literature. Am J Med Qual. 2009;24(3):196–204.CrossRefGoogle Scholar
  8. 8.
    Horwitz LI, Krumholz HM, Green ML, Huot SJ. Transfers of patient care between house staff on internal medicine wards: a national survey. Arch Intern Med. 2006;166(11):1173–7.CrossRefGoogle Scholar
  9. 9.
    Leonard M, Bonacum D, Taggart B. Using SBAR to improve communication between caregivers. London: Institute for Healthcare Improvement; 2006.Google Scholar
  10. 10.
    Langdale LA, Schaad D, Wipf J, Marshall S, Vontver L, Scott CS. Preparing graduates for the first year of residency: are medical schools meeting the need? Acad Med. 2003;78(1):39–44.CrossRefGoogle Scholar
  11. 11.
    Young JQ, Wachter RM. Academic year-end transfers of outpatients from outgoing to incoming residents: an unaddressed patient safety issue. JAMA. 2009;302(12):1327–9.CrossRefGoogle Scholar
  12. 12.
    Arora VM, Manjarrez E, Dressler DD, Basaviah P, Halasyamani L, Kripalani S. Hospitalist handoffs: a systematic review and task force recommendations. J Hosp Med. 2009;4(7):433–40.CrossRefGoogle Scholar
  13. 13.
    Arora VM, Eastment MC, Bethea ED, Farnan JM, Friedman ES. Participation and experience of third-year medical students in handoffs: time to sign out? J Gen Intern Med. 2013;28(8):994–8.CrossRefGoogle Scholar
  14. 14.
    Sharit J, McCane L, Thevenin DM, Barach P. Examining links between sign-out reporting during shift changeovers and patient management risks. Risk Anal. 2008;28(4):969–81.CrossRefGoogle Scholar
  15. 15.
    Horwitz LI, Moin T, Krumholz HM, Wang L, Bradley EH. Consequences of inadequate sign-out for patient care. Arch Intern Med. 2008;168(16):1755–60.CrossRefGoogle Scholar
  16. 16.
    Kitch BT, Cooper JB, Zapol WM, Marder JE, Karson A, Hutter M, et al. Handoffs causing patient harm: a survey of medical and surgical house staff. Jt Comm J Qual Patient Saf. 2008;34(10):563–570D.CrossRefGoogle Scholar
  17. 17.
    Angus S, Vu TR, Halvorsen AJ, Aiyer M, McKown K, Chmielewski AF, et al. What skills should new internal medicine interns have in July? A national survey of internal medicine residency program directors. Acad Med. 2014;89(3):432–5.CrossRefGoogle Scholar
  18. 18.
    Farnan JM, Paro JA, Rodriguez RM, Reddy ST, Horwitz LI, Johnson JK, et al. Hand-off education and evaluation: piloting the observed simulated hand-off experience (OSHE). J Gen Intern Med. 2010;25(2):129–34.CrossRefGoogle Scholar
  19. 19.
    Yudkowsky R, Downing S, Tekian A. Standard setting. In: Downing SM, Yudkowsky R, editors. Assessment in health professions education. New York: Routledge; 2009.Google Scholar
  20. 20.
    Association of American Medical Colleges. The Core Entrustable Professional Activities for Entering Residency Spring Update. 2015. https://www.aamc.org/download/427456/data/spring2015updatepptpdf.pdf. Accessed 11 Feb 2016.
  21. 21.
  22. 22.
  23. 23.
    Hollander M, Wolfe DA. Nonparametric statistical methods. 2nd ed. New York: Wiley; 1999.Google Scholar
  24. 24.
    Torre DM, Reed DA. Optimizing handoff training and outcomes in medical education. J Gen Intern Med. 2013;28(8):980–1.CrossRefGoogle Scholar
  25. 25.
    Sozener CB, Lypson ML, House, JB, Hopson LR, Dooley-Hash SL, Hauff S, et al. Reporting achievement of medical student milestones to residency program directors: an educational handover. Acad Med. 2016;91:676–84.Google Scholar
  26. 26.
    Santen SA, Rademacher N, Heron SL, Khandelwal S, Hauff S, Hopson L. How competent are emergency medicine interns for level 1 milestones: who is responsible? Acad Emerg Med. 2013;20(7):736–9.CrossRefGoogle Scholar
  27. 27.
    Edmond M, Roberson M, Hasan N. The dishonest dean's letter: an analysis of 532 dean's letters from 99 US medical schools. Acad Med. 1999;74(9):1033–5.CrossRefGoogle Scholar

Copyright information

© International Association of Medical Science Educators 2016

Authors and Affiliations

  1. 1.Department of Medicine, Division of Internal MedicineUniversity of FloridaGainesvilleUSA
  2. 2.Anaclerio Learning and Assessment CenterGainesvilleUSA
  3. 3.Department of Medicine, Division of Hematology and OncologyUniversity of FloridaGainesvilleUSA
  4. 4.Graduate Medical Education, College of MedicineUniversity of FloridaGainesvilleUSA
  5. 5.College of Medicine, Office for Educational AffairsUniversity of FloridaGainesvilleUSA

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