The Accreditation Council for Graduate Medical Education Common Program Requirements mandate that all residency programs need to monitor and ensure resident competency in patient handoffs.1 Changes in resident duty hours have increased the volume and complexity of handoffs and have increased the use of ''bridge'' or ''float'' residents who may not have prior knowledge of the patients. Ensuring proper creation and maintenance of the written sign-out is critical in this environment. Existing curricula to teach sign-out communication to residents have focused almost exclusively on verbal handoffs.2 Tools to facilitate teaching, monitoring, and evaluation of written sign-outs are especially lacking. This becomes even more important given the focus on educational milestones related to written communication, such as providing ''legible, accurate, complete, and timely written communication that is congruent with medical standards. '' 3 What Is KnownStudies suggest that written sign-outs are often plagued by medication errors, including omissions and erroneous information. Often, these errors result from failure to keep the sign-out updated. 4 Although the growing adoption of electronic health records can streamline documentation through linking data to sign-out applications, cut and paste problems and information overload may still occur.
5Ensuring proper creation and maintenance of the written sign-out is critical in today's environment.Structured templates for documenting handoff information are recommended by professional organizations.
6A recent, appreciative-inquiry study 7 in a large internal medicine training program found that handoffs varied widely in the absence of an educational curriculum and that a consistent methodology for sign-out organization is key.One promising technique for teaching written sign-outs is the use of practice audits, which can promote reflection on past performance and facilitate transfer of knowledge into actual clinical practice.
8The UPDATED ApproachThe UPDATED educational approach to teaching written sign-outs emphasizes the importance of the following attributes of sign-outs:Updated administrative data
Deficits in organization and efficiency can disproportionately affect resident performance and delay milestone achievement. Many residents would benefit from detailed frameworks and assistance with new approaches to basic elements of daily work.
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