Association between hand-off patients and subject exam performance in medicine clerkship students.
BACKGROUND
Teaching hospitals increasingly rely on transfers of patient care to another physician (hand-offs) to comply with duty hour restrictions. Little is known about the impact of hand-offs on medical students.


OBJECTIVE
To evaluate the impact of hand-offs on the types of patients students see and the association with their subsequent Medicine Subject Exam performance.


METHODS
Observational study over 1 year.


METHODS
Third-year medical students in an Inpatient Medicine Clerkship at five hospitals with night float systems.


METHODS



METHODS
Medicine Subject Exam at the end of the clerkship; explanatory variables: number of fresh (without prior evaluation) and hand-off patients, diagnoses, subspecialty patients, and full evaluations performed during the clerkship, and United Stated Medical Licensing Examination (USMLE) Step I scores.


RESULTS
Of the 2,288 patients followed by 89 students, 990 (43.3%) were hand-offs. In a linear regression model, the only variables significantly associated with students' Subject Exam percentile rankings were USMLE Step I scores (B = 0.26, P < 0.001) and the number of full evaluations completed on fresh patients (B =0.20, P = 0.048; model r (2) = 0.58). In other words, for each additional fresh patient evaluated, Subject Exam percentile rankings increased 0.2 points. For students in the highest quartile of Subject Exam percentile rankings, only Step I scores showed a significant association (B = 0.22, P = 0.002; r (2) = 0.5). For students in the lowest quartile, only fresh patient evaluations demonstrated a significant association (B = 0.27, P = 0.03; r (2) = 0.34).


CONCLUSIONS
Hand-offs constitute a substantial portion of students' patients and may have less educational value than "fresh" patients, especially for lower performing students.
Lang
Valerie J
VJ
University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box MED-HMD, Rochester, NY 14642, USA. Valerie_Lang@urmc.rochester.edu
Mooney
Christopher J
CJ
O'Connor
Alec B
AB
Bordley
Donald R
DR
Lurie
Stephen J
SJ
D002982:Clinical Clerkship / Q000379:methods / Q000592:standards*; D002983:Clinical Competence / Q000592:standards*; D003266:Continuity of Patient Care / Q000592:standards*; D004521:Educational Measurement / Q000379:methods / Q000592:standards*; D006801:Humans; D013337:Students, Medical