Jennifer Stojan, M.D., M.D., University of Michigan Medical School, Ann Arbor, MI, Jocelyn Schiller, M.D., University of Michigan Medical School, Ann Arbor, MI, Jennifer Christner, M.D., Upstate Medical University, Syracuse, NY, Paula Ross, University of MIchigan Medical School, Ann Arbor, MI, Monica Lypson, M.D., University of Michigan, Ann Arbor, MI, Sarah Middlemas, University of Michigan Medical School, Ann Arbor, MI, Patricia Mullan, M.D., University of Michigan Medical School, Ann Arbor, MI, Tom Fitzgerald, M.D., University of Michigan Medical School, Ann Arbor, MI
Background:Failures in communication are the leading root cause of sentinel events. Accreditors have long recognized this and mandate handoff education. The COMSEP and APPD Pediatric Subinternship (sub-I) Curriculum includes conveying concise, pertinent information at the time of handoffs, but there is little evidence in the literature that fourth year students (M4s) are being taught handoff skills. We enhanced available resources and developed a handoff curriculum as well as provided direct observation and feedback of actual patient handoffs for M4s.
Methods:Since the start of academic year 2012, M4s completing a pediatric inpatient sub-I at the University of Michigan participated in a 2 hour workshop on handoffs. During the sub-I, M4s were observed giving handoffs on 3 to 4 occasions by trained faculty members using an assessment tool adapted from a previously published SIGNOUT mnemonic. For each of the 17 items, the M4 scored 0=not done, 1= needs improvement, 2= done. Faculty, peer and self evaluations were recorded.
Results 19 M4s were observed giving a total of 88 patient handoffs. Preliminary data analysis revealed that performance improved with each observation: average score given by faculty on first observation = 23 (S.D. 1.92), second observation = 31 (S.D. 3.72), third observation = 32 (S.D. 2.39), fourth observation = 33 (S.D. 1.64). Further item analysis and correlations between faculty, peer and self evaluations will be available this winter. Evaluations of the workshop and feedback were overwhelmingly positive with 100% of M4s agreeing they would recommend the workshop to a peer and teaching was effective. Evaluations of the overall sub-I also trended positively, with overall quality of the rotation scoring 4.68 (S.D. 0.48) on a 5-point Likert scale compared to 4.42 (S.D. 0.55) for the two years prior, p=0.09. M4s specifically commented on the value of the handoff curriculum.
Conclusions:M4 performance on giving handoffs improved with a curriculum incorporating direct observation and feedback. Further research will be necessary to assess the long-term impact of this curriculum on handoff performance.