title: Effect of handoff skills training for students during the medicine clerkship: a quasi-randomized study.
abstract: Continuity is critical for safe patient care and its absence is associated with adverse outcomes. Continuity requires handoffs between physicians, but most published studies of educational interventions to improve handoffs have focused primarily on residents, despite interns expected to being proficient. The AAMC core entrustable activities for graduating medical students includes handoffs as a milestone, but no controlled studies with students have assessed the impact of training in handoff skills. The purpose of this study was to assess the impact of an educational intervention to improve third-year medical student handoff skills, the durability of learned skills into the fourth year, and the transfer of skills from the simulated setting to the clinical environment. Trained evaluators used standardized patient cases and an observation tool to assess verbal handoff skills immediately post intervention and during the student's fourth-year acting internship. Students were also observed doing real time sign-outs during their acting internship. Evaluators assessed untrained control students using a standardized case and performing a real-time sign-out. Intervention students mean score demonstrated improvement in handoff skills immediately after the workshop (2.6-3.8; p < 0.0001) that persisted into their fourth year acting internship when compared to baseline performance (3.9-3.5; p = 0.06) and to untrained control students (3.5 vs. 2.5; p < 0.001, d = 1.2). Intervention students evaluated in the clinical setting also scored higher than control students when assessed doing real-time handoffs (3.8 vs. 3.3; p = 0.032, d = 0.71). These findings should be useful to others considering introducing handoff teaching in the undergraduate medical curriculum in preparation for post-graduate medical training. Trial Registration Number NCT02217241.
authors.affiliation: Division of Hospital Medicine, Department of Medicine, The George Washington University School of Medicine and Health Sciences, 900 23rd St, NW, Washington, DC, 20037, USA. jreyes@mfa.gwu.edu.
authors.forename: Juan A
authors.initials: JA
authors.lastname: Reyes
authors.affiliation: The Clinical Learning and Simulation Skills Center, Office of Medical Education, The George Washington University School of Medicine and Health Sciences, Washington, DC, 20037, USA.
authors.forename: Larrie
authors.initials: L
authors.lastname: Greenberg
authors.affiliation: The George Washington University Medical Faculty Associates Biostatistics Core, Washington, DC, 20037, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Amdur
authors.affiliation: Division of Hospital Medicine, Department of Medicine, The George Washington University School of Medicine and Health Sciences, 900 23rd St, NW, Washington, DC, 20037, USA.
authors.forename: James
authors.initials: J
authors.lastname: Gehring
authors.affiliation: Division of Hospital Medicine, Department of Medicine, The George Washington University School of Medicine and Health Sciences, 900 23rd St, NW, Washington, DC, 20037, USA.
authors.forename: Linda G
authors.initials: LG
authors.lastname: Lesky
mesh_terms: D002982:Clinical Clerkship; D002983:Clinical Competence; D006801:Humans; D007396:Internship and Residency; D062209:Patient Handoff / Q000592:standards*; D013337:Students, Medical
keywords: Handoff; Handover; Medical education-clinical skills training; Medical education-undergraduate; Signout; Transfer of care