February 2020

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Handoff Education

Patient Handoff Education: Are medical schools catching up? Davis R, Davis J, Berg K, et al. American Journal of Medical Quality.2018;33 (2):140-146.

https://doi.org/10.1177%2F1062860617719128

Reviewed by Hadley Bloomhardt, Laurie Murray, and Suzanne Friedman

 

 

What was the study question?   What type of handoff training is experienced during undergraduate medical education and what are the perceptions surrounding the handoff process among a group of interns across a five year period?

How was the study done? Surveys were distributed to a cohort of interns across several specialties at a single institution during their orientation between the years 2012-2016. Surveyed interns reported handoff experiences, observation, and patient safety perceptions.

What were the results? Nearly all of the interns surveyed reported believing patients experience adverse events because of inadequate handoffs.  The majority of interns reported having some form of training on handoffs during medical school, though most were for less than 1 hour. Interns in the latter two years of the study spent significantly more time on handoff training than those in the prior three years. Statistically significant increases in physician led training, didactic instruction, role play and the use of standardized templates occurred over time.

What are the implications of these findings? Though prevalence of handoff education in medical students increased over the 5 years of this study, nearly one quarter of students reported receiving no handoff training. The importance of this type of education is highlighted by its inclusion in AAMC entrustable professional activities (EPAs). While there is no consensus on the optimal approach to handoff education, medical schools have incorporated role play and other hands-on practice techniques to enhance training of these critical EPAs for students.  To date, few curricula fully address all necessary skills and behaviors students need to acquire and best practices are needed.

Editor’s note: It is heartening to note that there has been a recent trend of more instruction  devoted to handoff skills and techniques in medical school likely spurred by inclusion of those skills in the AAMC EPAs. Obviously there is more work to be done. (RR)

 Peer mentoring—semi-structured, mostly beneficial

Altonji S, Baños JH & Harada CN. Perceived Benefits of a Peer Mentoring Program for FirstYear Medical Students.  Teaching and Learning in Medicine (2019), 31:4, 445-452.

https://dx.doi.org/10.1080/10401334.2019.1574579

Reviewed by: Amit Pahwa

What was the study question?  What are the perceived benefits and satisfaction of first year medical students of a semistructured, informal cross year peer mentoring program?

How was study done? Participants were 190 first year students (mentees) and 112 second year students (mentors) at University of Alabama School of Medicine.  Learning community representatives assigned mentors to mentees. Mentors either attended or viewed a training session on importance of mentoring, sample meeting ideas, and institutional resources or students. Only one mentormentee meeting was required but monthly were encouraged. Outcomes were assessed by a survey of first year students, developed based on existing literature of mentorship effectiveness and themes from a focus group of first year medical students. The four outcomes assessed were: overall satisfaction, perceived academic benefit, perceived non-academic benefit and perceived clinical benefit.

What were the results?  Survey response rate was 49.5% (94 of 190 students). Mentees overall were satisfied with the program (mean of score of 7.47 on 10 point scale). Mentees perceived the best academic benefit was helping make their studying more effective. The best predictor of satisfaction and academic benefit was if the mentor provided guidance on how to succeed in medical school. The best nonacademic benefit was decreasing anxiety. Mentees mostly disagreed that the mentors made their clinical skills better. Other predictors of outcomes were if the mentor had expertise in areas of mentee need, and regular involvement with the mentor.

What are the implications?  This study shows many positive perceived effects of peer mentoring for medical students and with little training of the mentors. However the level of satisfaction was not as high as expected with a mean score of 7.47 and standard deviation of 2.45. Not surprisingly mentors ability to help with clinical skills was going to be perceived as low since many of the second year students have not had a lot of clinical experience as a third or fourth year students. Since many schools utilize learning communities, this could be easily implemented.

Editor’s Comments: This study discusses the perceived benefits from the perspective of social congruence, or closeness in authority or experience between individuals, and how that may help new students navigate the many challenges of medical school and drive the benefits of peer mentoring (KFo).

A primer for budding researchers

Varpio L, Paradis E, Uijtdehaage S, Young M. The Distinctions Between Theory, Theoretical Framework, and Conceptual Framework.

Acad Med. ePub ahead of print. https://www.doi.org/10.1097/ACM.0000000000003075.

Reviewed by Gary Beck Dallaghan

What was the study question? Medical education journals have an expectation that submissions include a discussion about theory, theoretical frameworks, and/or conceptual frameworks.  This work seeks to clarify the meaning of these terms and how they are used in health professions education research.

What do these terms mean? A theory presents an abstract description of relationships between concepts to provide understanding of the world.  Theories can be descriptive, explanatory, emancipatory, disruptive, or predictive.  A theoretical framework presents logically developed and connected concepts or premises that stem from one or more theories.  “In short, a theoretical framework is a reflection of the work the researcher engages in to use a theory in a given study.  A conceptual framework provides justification for why a study should be conducted by describing what is known, what the gaps are, and what methods will be used.

What were the results? The authors provided examples of how these concepts fit within objectivist deductive (OD) and subjectivist inductive (SI) research approaches.  For OD researcher, a theory is the starting point, seeking to identify a causal relationship using hypotheses derived from the theory.  In OD studies, the theoretical and conceptual frameworks are constructed prior to data collection and essentially remains unchanged throughout the study. SI research does not begin with a hypothesis, but instead seeks to explain a phenomenon.  In SI research, a theory could inform the study, be developed as a result of the study, or be an interpretative tool for the data collected. Depending on the study design chosen will inform the SI theoretical framework. SI conceptual frameworks likely evolve during the study.

What are the implications? These concepts are foundational elements of research.  Clearly articulating the theory or theories influencing your research will help provide a more in-depth analytical report of your work.

Editor’s Note: Navigating the complex interactions of theory and data gathering is especially important in qualitative research but applies to all forms of research.  This article provides definitions that are a good starting point. (JG)