Background: Increased fragmentation of inpatient medical care requires hospitalists to frequently hand off their patients to other providers. Communication breakdown during transitions of care is a major cause of adverse events. Direct observation of handoff encounters and performance feedback can help providers develop the skills needed to safely transition patients across the health system and from daytime to nighttime. We developed a curriculum to train upper-level residents in observation and feedback skills used to supervise and mentor junior trainees during inpatient handoffs.
Purpose: Using videotaped sample handoff encounters, group discussion, and role-play as educational tools, the purpose of this curriculum was to improve trainees’ ability to evaluate sample handoff encounters using a standardized rubric, and to provide an opportunity to practice providing feedback on these sample encounters.
Description: A total of 29 higher-level residents participated in this curriculum. Learners were provided with a brief didactic on best practices for inpatient handoffs and were provided with a grading rubric based on these principles; target behaviors included discussion of patient acuity, inclusion of an up-to-date clinical history and a clear to-do list, and a comprehensive discussion of anticipatory guidance. They also graded encounters for appropriate pacing. Learners were shown two handoff encounters presented as videotapes and asked to grade each encounter using the rubric provided. After each videotape, a hospitalist engaged learners in a group debrief, with the goal of reaching a consensus on each encounter’s adherence to best practices. To evaluate the effectiveness of the curriculum, each learner’s rubric was compared with that of a curriculum author. There was modest agreement between the author and the learners (83.5% for tape 1 and 79% for tape 2); areas with below-average agreement included anticipatory guidance, handoff pace, and the presence of closed-loop communication. Finally, learners practiced providing feedback on the handoff encounters to their peers.
Conclusions: A novel curriculum provided an opportunity for learners to practice evaluation and feedback of sample handoff encounters, with the goal of empowering learners to engage junior trainees in workplace-based evaluation and feedback. There was a modest agreement between the curriculum author and the learners, suggesting that learners were able to identify some but not all behaviors consistent with best practices. Further research is necessary to evaluate the impact of this curriculum on workplace-based performance feedback and quality of patient handoffs.