Few medical students receive formal training in how to perform patient handoffs effectively and efficiently, says Vineet Arora, MD, FHM, who chairs an SHM task force on improving handoffs. Most pick it up on the job, but Dr. Arora and her colleagues at the University of Chicago—where she is associate director of the internal-medicine residency program—and at the University of Michigan have been exploring ways to improve the process through education.1 Handoffs and care transitions are a major focus for hospital quality-improvement (QI) efforts nationally.
Dr. Arora’s group created an “observed simulation handoff experience” for medical students and residents, “offering an air of authenticity to the experience without the high-risk environment of learning on live patients,” she explains. Students who have completed an interactive training session perform the simulation at a computer station. They are provided with two types of information: static data about the mock patient—including such information as diagnosis, primary-care physician, and code status from a history and physical report—and video clips offering “a virtual, real-time barrage of constant updates” about the patient’s changing clinical status.
“They are given some time to extract and synthesize the important data for a handoff, and then they go in and perform the handoff in person to a ‘standardized receiver,’ ” Dr. Arora explains. The receiver is a resident or other clinician familiar both with the case and how the handoff should go, and who then provides a standardized evaluation, grade, and feedback.
“The goal is to teach students the triggers that need to be incorporated into an effective handoff,” Dr. Arora says. Her group also reviewed concepts of good handoffs from the medical literature and worked with a psychology expert in human communication.
“How do you teach people to give good handoffs? We don’t know all of the answers, but we think you have to start somewhere,” she says. “Technology can be a great facilitator to make handoffs go better. It’s not a perfect substitute for face-to-face, interactive handoffs, but it can dramatically inform care transitions.”
Larry Beresford is a freelance writer based in Oakland, Calif.
1. Farnan JM, Paro JA, Rodriguez RM, et al. Hand-off education and evaluation: piloting the observed simulated hand-off experience (OSHE). J Gen Intern Med. 2010;25(2):129-134.