Clinical clerkship students' perceptions of (un)safe transitions for every patient.
OBJECTIVE
As calls for training and accreditation standards around improved patient care transitions have recently increased, more publications describing medical student education programs on care transitions have appeared. However, descriptions of students' experience with care transitions and the sender/receiver communication that supports or inhibits them are limited. To fill this gap, the authors developed this project to understand students' experiences with and perceptions of care transitions.


METHODS
At the start of a patient safety intersession at the Medical College of Wisconsin (2010), 193 third-year medical students anonymously wrote descriptions of critical incidents related to care transitions they had witnessed that evoked a strong emotional reaction. Descriptions included the emotion evoked, clinical context, and types of information exchanged. The authors analyzed the incident descriptions using a constant comparative qualitative methodology.


RESULTS
Analysis revealed that 111 of the 121 medical students (92%) who disclosed emotional responses had strong negative reactions to unsuccessful transitions, experiencing frustration, irritation, fear, and anger. All of these negative emotions were associated with lack of or poor communication between the sender and receiver: ambiguous roles and responsibilities, insufficient detailing of the patient's medical course, inadequate identification of the people involved in the transition, incomplete delineation of what the patient needed, and unclear reasons for the transition.


CONCLUSIONS
Third-year medical students' descriptions of care-transition incidents reveal high rates of strong negative emotions and of communication gaps that may adversely affect patient care. Results support curricular innovations that align students' needs and experiences with safe patient care transitions.
Dr. Koch is assistant professor of family and community medicine, Medical College of Wisconsin, Milwaukee, Wisconsin. Dr. Simpson is adjunct professor of family and community medicine, Medical College of Wisconsin, and medical education program director, Aurora Health Care, Milwaukee, Wisconsin. Dr. Toth is associate professor of medicine and pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin. Dr. Marcdante is professor of pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin. Dr. Densmore is assistant professor of pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin. Dr. Young is assistant professor of family and community medicine, Medical College of Wisconsin, Milwaukee, Wisconsin. Dr. Weisgerber is associate professor of pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin. Dr. Morzinski is associate professor of family and community medicine, Medical College of Wisconsin, Milwaukee, Wisconsin. Dr. Havas is associate professor of family and community medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
Paul E
PE
Koch
Deborah
D
Simpson
Heather
H
Toth
Karen
K
Marcdante
Emily
E
Densmore
Staci
S
Young
Michael
M
Weisgerber
Jeffrey A
JA
Morzinski
Nancy
N
Havas
D001291:Attitude of Health Personnel; D002982:Clinical Clerkship; D003142:Communication; D003266:Continuity of Patient Care / Q000592:standards; D006801:Humans; D062209:Patient Handoff / Q000592:standards*; D036301:Qualitative Research; D013337:Students, Medical / Q000523:psychology*