title: Internal medicine postgraduate training and assessment of patient handoff skills.
abstract: BACKGROUND
  Effective communication during patient care transitions is essential for high-quality patient care.
  
  
  OBJECTIVE
  The purpose of this study was (1) to objectively assess patient handoff skills of internal medicine residents, and (2) to evaluate correlations between clinical experience and patient handoff skill self-assessment with directly observed skill.
  
  
  METHODS
  We studied simulated patient handoffs in postgraduate year (PGY)-1 and PGY-2 residents between July 2011 and September 2011, using a standardized scenario in an observed structured handoff exam (OSHE). Our design was a posttest-only, with nonequivalent groups. Assessment used a previously published checklist for evaluating handoff skills. Residents were asked about clinical experience with patient handoffs and about their self-confidence in performing a patient handoff independently. We evaluated between-group differences on OSHE checklist performance, patient handoff experience, and self-confidence and used multiple regression analyses to assess the association between performance, experience, and confidence.
  
  
  RESULTS
  Forty-seven PGY-1 residents and 38 PGY-2 residents completed the study. Interrater reliability was substantial (intraclass correlation  =  0.68). There was no significant difference in OSHE performance by PGY-1 residents (mean  =  79%, SD  =  4.6) and PGY-2 residents (mean  =  82%; SD  =  7.6; P  =  .07). The PGY-2 residents were significantly more experienced (P < .001) and confident (P < .001) than PGY-1 residents were, yet clinical experience and self-confidence did not significantly predict OSHE performance.
  
  
  CONCLUSIONS
  Clinical experience and self-assessment do not predict skills in simulated patient handoffs, and residents with substantial clinical experience still benefit from further skills development.
authors.forename: Aashish
authors.initials: A
authors.lastname: Didwania
authors.forename: Michael
authors.initials: M
authors.lastname: Kriss
authors.forename: Elaine R
authors.initials: ER
authors.lastname: Cohen
authors.forename: William C
authors.initials: WC
authors.lastname: McGaghie
authors.forename: Diane B
authors.initials: DB
authors.lastname: Wayne