Key stakeholder opinions for a national learner education handover

Abstract

Background Sharing information about learners during training is seen as an important component supporting learner progression and relevant to patient safety. Shared information may cover topics from accommodation requirements to unprofessional behavior. The purpose of this study was to determine the views of key stakeholders on a proposed national information sharing process during the transition from undergraduate to postgraduate medical education in Canada, termed the Learner Education Handover (LEH). Method Key stakeholder groups including medical students, resident physicians, residency program directors, medical regulatory authority representatives, undergraduate medical education deans, student affairs leaders, postgraduate medical education deans participated in focus groups conducted via teleconference. Data were transcribed and coded independently by two coders, then analyzed for themes informed by principles of constructivist grounded theory. Results Sixty participants (33 males and 27 females) from 16 focus groups representing key stakeholder groups participated. Most recognized value in a national LEH that would facilitate a smooth learner transition from medical school to residency. Potential risks and benefits of the LEH were identified. Themes significant to the content , process and format of the LEH also emerged. Guiding principles of the LEH process were determined to include that it be learner-centered while supporting patient safety, resident wellness and professional behavior. The learner and representatives from their undergraduate medical education environment would each contribute to the LEH. Conclusions The LEH must advocate for the learner with respect for learner privacy, while promoting professionalism, patient safety and learner wellness.

Learner handover: Perspectives and recommendations from the front-line

“…In cases where they could not reach consensus, they consulted a third coder (VD). Once they had established an initial coding scheme, the coders grouped independent codes into overarching categories and subcategories identified directly from the data and by drawing on existing literature [6][7][8][9][10][12][13][14]. Once a complete round of coding and categorization was finalized, the third coder (VD) independently reviewed all of the assigned codes to ensure consistency in terminology and coding practice.…”

“…While learner handover is well-aligned with the goals of CBME, we know little regarding the potential risks, benefits, or strategies for its successful implementation within CBME [5]. Current views regarding learner handover in medical education vary substantially [6][7][8][9][10][11][12][13][14]. Some suggest that learner handover may be beneficial and lead to: a) improved learning through more tailored education and support [8][9][10][11][12], b) improvements in a supervisor's ability to assess learners across competencies [2,8], c) fewer informal discussions of learners (i.e., 'hallway talk') [9,11], d) increased assessor accountability [11], and e) increased patient safety through the early identification of weak or problematic learners [8,[10][11][12].…”

“…Others have raised concerns that learner handover would introduce bias into the assessment process [6,7,9,10,12,13]. Specifically, discussions or documentation regarding the prior performance of learners may result in them being treated differently, labelled, or stigmatized by future educators [6,7,9,10,12,13]. This, in turn, could result in self-fulfilling prophecies-where both learners and assessors behave in a way that aligns with the previous judgements of others [7].…”

“…This, in turn, could result in self-fulfilling prophecies-where both learners and assessors behave in a way that aligns with the previous judgements of others [7]. Some argue that, depending on the content of the discussions and assessment reports, learner handover may violate a learner's right to confidentiality and privacy [6,7,10,12,13].…”

“…To date, the literature largely reflects opinions held by educational leaders, including the directors of clinical courses and postgraduate programs and associate deans [6][7][8][9][10][12][13][14]. The perspectives of clinical supervisors, who directly train and assess learners and represent the majority of faculty members involved in formal or informal learner handover, are less well described in the literature.…”