The Modified, Multi-patient Observed Simulated Handoff Experience (M-OSHE): Assessment and Feedback for Entering Residents on Handoff Performance

Abstract

BACKGROUND: Despite the identification of transfer of patient responsibility as a Core Entrustable Professional Activity for Entering Residency, rigorous methods to evaluate incoming residents' ability to give a verbal handoff of multiple patients are lacking. AIM: Our purpose was to implement a multi-patient, simulation-based curriculum to assess verbal handoff performance. SETTING: Graduate Medical Education (GME) orientation at an urban, academic medical center. PARTICIPANTS: Eighty-four incoming residents from four residency programs participated in the study. PROGRAM DESCRIPTION: The curriculum featured an online training module and a multi-patient observed simulated handoff experience (M-OSHE). Participants verbally Bhanded off^three mock patients of varying acuity and were evaluated by a trained Breceiver^using an expertinformed, five-item checklist. PROGRAM EVALUATION: Prior handoff experience in medical school was associated with higher checklist scores (23 % none vs. 33 % either third OR fourth year vs. 58 % third AND fourth year, p = 0.021). Prior training was associated with prioritization of patients based on acuity (12 % no training vs. 38 % prior training, p = 0.014). All participants agreed that the M-OSHE realistically portrayed a clinical setting. CONCLUSIONS: The M-OSHE is a promising strategy for teaching and evaluating entering residents' ability to give verbal handoffs of multiple patients. Prior training and more handoff experience was associated with higher performance, which suggests that additional handoff training in medical school may be of benefit.KEY WORDS: medical education; medical student and residency education; communication skills.

Improving Handoffs: Implementing a Training Program for Incoming Internal Medicine Residents

“…Previous studies reported that simulation is an effective way to teach handoffs. 4,5,11 However, most evaluated a 1-year experience. Our study evaluated a handoff training program over 3 years and demonstrated continued compliance with I-PASS by evaluating handoff documents throughout the year.…”

“…Several residency programs developed curricula to teach handoffs using I-PASS, and many used simulation to assess residents' skills. These innovations led to improved knowledge 4,5 ; however, there is limited postintervention data on changes in handoff practice. 6,7 Additionally, as entrustable professional activities are incorporated into medical school training, including handoffs, the role of teaching handoff skills to interns as they begin residency is unclear.…”

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“…Previous reviews of the clinical handover literature have concluded that, although considerable attention has been directed to researching and implementing improved care transition processes, this has not yet led to a clear articulation of best practices. Current handover practices are therefore not as robust or efficient as they might be, thus presenting a significant risk to patient safety . In addition, systems factors, such as increased handovers for patient care resulting from mandated restrictions in duty hours for junior doctors, have led to more opportunities for errors …”

“…Current handover practices are therefore not as robust or efficient as they might be, thus presenting a significant risk to patient safety. 1,2,4,5 In addition, systems factors, such as increased handovers for patient care resulting from mandated restrictions in duty hours for junior doctors, have led to more opportunities for errors. 1,2,6,7 Communication skills training is frequently proposed as a way to improve handover safety and efficiency, which in turn has led to the development of various tools to assist structured dialogue between clinicians about a patient's status.…”

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