Purpose: A mandatory graded “Transitions of Care” assignment was developed for students enrolled in the Medicine Clerkship. Students were asked to conduct a post-discharge follow-up phone call using the Agency for Healthcare Research and Quality (AHRQ) tool. In addition, students were asked to identify barriers to safe discharge of their patient and to consider ways in which their future practice could be improved. We performed a qualitative analysis of the assignments and developed themes and sub-themes, using the analytic program Dedoose. The frequency with which themes were identified by students was tabulated.
Description: Ninety (90) students enrolled in the Medicine Clerkship submitted a transitions of care assignment. Issues with patients’ understanding of their discharge diagnosis were identified in 27/83 (32.5%), including inability to articulate their diagnosis. A majority (46/89, 51.7%) of patients had medication-related issues, most commonly incomplete understanding of indications, inability to obtain medications, noncompliance and side effects. The phone call revealed issues with post-discharge follow-up in 44/89 (49.4%) patients, leading to failure to attend the appointment due to lack of transportation or forgetting the appointment. Feedback on the patient’s condition, whether improved or persistent, were incidentally received by students in 38 cases. Students identified a total of 201 barriers to discharge among 86 patients. These included issues with scheduling follow-up, poor care coordination, lack of social support systems and health care system-related problems, debilitation and cognitive impairment and lack of access to medications, equipment or transportation. Finally, students proposed 240 practice improvement interventions to improve transitions of care. The most common interventions related to increased patient education (42), and enhanced communication with patients (34) and their families (16). Improved interdisciplinary collaboration (33) and care coordination and discharge planning (18) were frequently noted, as well as greater attention to patient’s psychosocial and financial (26). Arranging follow-up and performing a post-discharge phone call were recommended.
Conclusions: Medical students learned robustly about systems-based practice from a transitions of care assignment, which included a post-discharge phone call. We believe that self-reflective practice and learning within the context of direct patient care offers opportunities for future practice improvement as medical students transition their patients’ care.