J. Peschman1, J. Paul1, T. Webb1, P. Redlich1 1Medical College Of Wisconsin,Division Of Surgical Education,Milwaukee, WI, USA
Introduction: With implementation of ACGME duty hour restrictions an increased reliance on night float systems and cross coverage has occurred. Therefore, developing methods for evaluating and improving an incoming intern’s ability to perform effective information transmission during patient handoffs is crucial to enhance patient safety. To this end, we have surveyed incoming interns since the new duty hour implementation about their handoff training during medical school and conducted dedicated handoff training sessions during our PGY-1 Protected Block Curriculum (PBC) prior to their start on July 1st.
Methods: Interns have completed surveys and training sessions since 2012. The formal handoff training sessions occurred prior to their start date and included assigned background reading, a didactic session, and a practical exercise. Direct assessment was conducted of each intern’s ability to correctly identify 3 key and essential points required for transmission during mock handoffs using standardized patient scenarios prior to and following the didactic session. Follow up surveys were completed at 2.5 months to evaluate their experiences with handoffs and handoff training.
Results: Over 3 years, 41 interns representing 25 medical schools participated. Interns reported only 28% of their medical schools provided formal handoff training. This rate increased from 15% to 56% from 2012 to 2014. Over 90% reported having observed or participated in handoffs on clinical rotations. Comparing the 2012, 2013 and 2014 classes, the average incoming comfort level with providing a handoff increased each year; 2.8±1.0 (SD), 3.4±0.9, 3.5±0.7 (1-5 scale 5=Very Comfortable). 89% of intern pairs transmitted and identified at least 2 of 3 key points during mock handoffs prior to the didactic session compared to 100% after the session. Comfort levels increased to 3.6±1.0, 3.7±0.8, and 4.0±0.0 following the training session over the three years. At 2.5 months follow up, 58% wished they had more training during medical school, 23% wanted additional training during the PBC, and 50% felt patient care had been jeopardized by poor handoffs in their recent clinical experience.
Conclusion: Changes to duty hours provide unique patient care challenges that require effective handoffs. Despite limited formal training prior to residency, most interns have enough baseline experience to perform reasonably well in mock patient handoffs. Dedicated teaching sessions just prior to residency only moderately improved resident comfort compared to medical school experiences. Most concerning, after less than 3 months of clinical experience, half of interns can identify instances where patient safety was jeopardized by poor handoffs possibly explaining why most wished they had more prior training. These results highlight the need for new efforts focused on enhanced handoff training in medical school that can be reinforced during residency.