Background: Medical errors commonly occur during transitions of care, but medical trainees receive little formal education in how to recognize and address those patients most at risk. Teaching third year medical students to identify risk factors for adverse events may highlight practice changes to enhance safety during transitions.
Purpose: To determine if a Transitions of Care Curriculum would highlight common systems issues experienced by patients during transition, and to examine how this curriculum might change students’ clinical approach and future decision-making.
Description: Third year medical students rotating through a 3-site Internal Medicine program from June 2016-April 2017 participated in a Transitions of Care Curriculum. At the beginning of the rotation, each group received a didactic focused on identifying risk factors for adverse events after discharge based on the SHM Project Boost 8Ps risk assessment screening tool (Problem medications, Psychological, Principal diagnosis, Polypharmacy, Poor health literacy, Patient support, Prior hospitalization, Palliative care). Students learned evidence-based approaches to assess patient retention and comprehension including the Ask-Teach-Ask strategy, which asks patients to recall recommendations, provides corrective information (as needed) and asks if there are further points to clarify. Students were also taught to use the Looking Ahead strategy, which seeks to problem solve with patients to anticipate potential obstacles. Students then received a standardized template, also modeled after Project Boost, to conduct a post-discharge phone call and called at least one patient to inquire about the patient’s transition. They formally wrote up their findings, reflected on how the exercise would alter future clinical decisions, and debriefed as a group at the end of the rotation.
Eleven didactic sessions were held, with 107 students participating in the curriculum. Ninety-nine (93%) completed the write up assignment in full. Of the 107 contacted patients, 65 (61%) experienced an adverse event related to a systems issue, with 101 systems issues identified in total. The most commonly identified issue was “lack of timely follow up” (30%), followed by “inadequate communication with the patient/caregiver” (26%). Changes to future practice that students described in their reflections mirrored the most commonly identified systems issues. Of 241 self-identified changes students would enact, 42% focused on improving communication with patients and caregivers and 13% would change their approach to patient education and anticipatory guidance. Third most common was “change in scheduling follow up appointments” (10%).
Conclusions: A clinical transitions curriculum helped students identify common systems issues encountered by patients post-hospitalization, and in turn led them to critically think about changing their future clinical practice to address these issues.