title: Using standardized videos to validate a measure of handoff quality: the handoff mini-clinical examination exercise.
abstract: BACKGROUND
  The most recent iteration of the Accreditation Council for Graduate Medical Education duty-hour regulations includes language mandating handoff education for trainees and assessments of handoff quality by residency training programs. However, there is a lack of validated tools for the assessment of handoff quality and for use in trainee education.
  
  
  METHODS
  Faculty at 2 sites (University of Chicago and Yale University) were recruited to participate in a workshop on handoff education. Video-based scenarios were developed to represent varying levels of performance in the domains of communication, professionalism, and setting. Videos were shown in a random order, and faculty were instructed to use the Handoff Mini-Clinical Examination Exercise (CEX), a paper-based instrument with qualitative anchors defining each level of performance, to rate the handoffs.
  
  
  RESULTS
  Forty-seven faculty members (14 at site 1; 33 at site 2) participated in the validation workshops, providing a total of 172 observations (of a possible 191 [96%]). Reliability testing revealed a Cronbach α of 0.81 and Kendall coefficient of concordance of 0.59 (>0.6 = high reliability). Faculty were able to reliably distinguish the different levels of performance in each domain in a statistically significant fashion (ie, unsatisfactory professionalism mean 2.42 vs satisfactory professionalism 4.81 vs superior professionalism 6.01, P < 0.001 trend test). Two-way analysis of variance revealed no evidence of rater bias.
  
  
  CONCLUSIONS
  Using standardized video-based scenarios highlighting differing levels of performance, we were able to demonstrate evidence that the Handoff Mini-CEX can draw reliable and valid conclusions regarding handoff performance. Future work to validate the tool in clinical settings is warranted.
authors.affiliation: Department of Medicine, University of Chicago, Chicago, Illinois; Pritzker School of Medicine, University of Chicago, Chicago, Illinois.
authors.forename: Vineet M
authors.initials: VM
authors.lastname: Arora
authors.forename: Saba
authors.initials: S
authors.lastname: Berhie
authors.forename: Leora I
authors.initials: LI
authors.lastname: Horwitz
authors.forename: Mark
authors.initials: M
authors.lastname: Saathoff
authors.forename: Paul
authors.initials: P
authors.lastname: Staisiunas
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Farnan
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D004493:Education / Q000379:methods / Q000592:standards; D005180:Faculty, Medical / Q000592:standards*; D006801:Humans; D007396:Internship and Residency / Q000379:methods / Q000592:standards*; D062209:Patient Handoff / Q000592:standards*; D010865:Pilot Projects; D015203:Reproducibility of Results; D014741:Video Recording / Q000379:methods / Q000592:standards*