Top

Published in:

01-02-2010 | Innovations in Education

Hand-off Education and Evaluation: Piloting the Observed Simulated Hand-off Experience (OSHE)

Authors: Jeanne M. Farnan, MD, MHPE, J. A. M. Paro, BA, R. M. Rodriguez, BA, S. T. Reddy, MD, L. I. Horwitz, MD, MPH, J. K. Johnson, MSPH, PhD, V. M. Arora, MD, MAPP

Published in: Journal of General Internal Medicine | Issue 2/2010

Abstract

Aim

The Observed Simulated Hand-off Experience (OSHE) was created to evaluate medical students’ sign-out skills using a real-time assessment tool, the Hand-off CEX.

Setting

Thirty-two 4th year medical students participated as part of an elective course.

Program description

One week following an interactive workshop where students learned effective hand-off strategies, students participated in an experience in which they performed a hand-off of a mock patient using simulated history and physical examination data and a brief video.

Program evaluation

Internal medicine residents served as standardized hand-off receivers and were trained on expectations. Students were provided feedback using a newly developed Hand-off CEX, based on the “Mini-CEX,” which rates overall hand-off performance and its components on a 9-point Likert-type scale. Outcomes included performance ratings and pre- and post-student self-assessments of hand-off preparedness. Data were analyzed using Wilcoxon signed-rank tests and descriptive statistics. Resident receivers rated overall student performance with a mean score of 6.75 (range 4–9, maximum 9). Statistically significant improvement was observed in self-perceived preparedness for performing an effective hand-off (67% post- vs. 27% pre-reporting ‘well-prepared,’ p < 0.009).

Discussion

This brief, standardized hand-off training exercise improved students’ confidence and was rated highly by trained observers. Future work focuses on formal validation of the Hand-off CEX instrument.

Available only for authorised users

ACGME Resident duty hours language. www.acgme.org/acwebsite/dutyhours/dh_lang703.pdf ; accessed October 9, 2009.

Horwitz LI, Krumholz HM, Green ML, Huot SJ. Transfers of patient care between house staff on the internal medicine wards: A national survey. Arch Intern Med. 2006;166:1173–7.CrossRefPubMed

Sharit J, McCane L, Thevenin DM, Barach P. Examining links between sign-out reporting during shift changeovers and patient management risks. Risk Anal. 2008;28(4):969–81.CrossRefPubMed

Kitch BT, Cooper JB, Zapol JM. Hand-offs causing patient harm: a survey of medical and surgical house staff. Jt Comm J Qual Improv. 2008;34:563–70.

Horwitz LI, Moin T, Krumholz HM, Wang L, Bradley EH. Consequences of inadequate sign-out for patient care. Arch Intern Med. 2008;168(16):1755–60.CrossRefPubMed

Singh H, Thomas EJ, Petersen LA, Studdert DM. Medical errors involving trainees: a study of closed malpractice claims from 5 insurers. Arch Intern Med. 2007;167(19):2030–6.CrossRefPubMed

Greenberg CC, Regenbogen SE, Studdert DM, et al. Patterns of communication breakdowns resulting in injury to surgical patients. J Am Coll Surg. 2007;204(4):533–40.CrossRefPubMed

Arora V, Kao J, Lovinger D, Seiden S, Meltzer DO. Medication discrepancies during patient hand-offs: Frequency, characteristics and potential to harm. J Hosp Med. 2007;2(S2):3.

Jagsi R, Kitch BT, Weinstein DF, Campbell EG, Hutter M, Weissman JS. Residents report on adverse events and their causes. Arch Intern Med. 2005;165(22):2607–13.CrossRefPubMed

10.

Arora V, Johnson J, Lovinger D, Humphrey HJ, Meltzer DO. Communication failures in patient sign-out and suggestions for improvement: a critical incident analysis. Qual Saf Health Care. 2005;14(6):401–7.CrossRefPubMed

11.

Institute of Medicine report. Resident Duty Hours: Enhancing Sleep, Supervision, and Safety. December 2008.

12.

Sinha M, Shriki J, Salness R, Blackburn PA. Need for standardized sign-out in the emergency department: a survey of emergency medicine residency and pediatric emergency medicine fellowship program directors. Acad Emerg Med. 2007;14(2):192–6.CrossRefPubMed

13.

Langdale L, Schaad D, Wipf J, Marshall S, Vontver L, Scott CS. Preparing graduates for the first year of residency: are medical schools meeting the need? Acad Med. 2003;78(1):39–44.CrossRefPubMed

14.

Harden RM, Stevenson M, Downie WW, Wilson GM. Assessment of clinical competence using objective structured examination. BMJ. 1975;1(5955):447–51.CrossRefPubMed

15.

Cohen DS, Colliver JA, Marcy MS, Fried ED, Swartz MH. Psychometric properties of a standardized-patient checklist and rating-scale form used to assess interpersonal and communication skills. Acad Med. 1996;71:S87–9.PubMedCrossRef

16.

Newble D. Techniques for measuring clinical competence: objective structured clinical examination. Med Educ. 2004;38:199–203.CrossRefPubMed

17.

Varkey P, Gupta P, Bennet KE. An innovative method to assess negotiation skills necessary for quality improvement. Am J Med Qual. 2008;23(5):350–5.CrossRefPubMed

18.

Zabar S, Hanley K, Stevens DL, Kalet A, et al. Measuring the competence of residents as teachers. JGIM. 2007;19(5):530–3.CrossRef

19.

Norcini J, Blank L, Duffy FD, Fortna GS. The Mini-CEX: A Method for Assessing Clinical Skills. Ann of Internal Med. 2003;138(6):476–81.

20.

Arora V, Johnson J. A model for building a standardized hand-off protocol. Joint Comm J Qual, Patient Saf. 2006;32(11):646–55.

21.

Arora VM, Johnson JK, Meltzer DO, Humphrey HJ. A theoretical framework and competency-based approach to improving hand-offs. Qual Saf Health Care. 2008;17(1):11–4.CrossRefPubMed

22.

Horwitz LI, Moin T, Green ML. Development and implementation of an oral sign-out skills curriculum. JGIM. 2007;22(10):1470–4.CrossRefPubMed

23.

Vidyarthi A, Arora VM, Schnipper J, et al. Managing discontinuity in academic medical centers: strategies for a safe and effective resident sign-out. J Hosp Med. 2006;1(4):257–66.CrossRefPubMed

24.

Carvalho PV, Dos Santos IL, Vidal MC. Safety implications of cultural and cognitive issues in nuclear power plant operation. Appl Ergon. 2005.

25.

Helmreich RL. On error management: lessons from aviation. BMJ. 2000;320:781–5.CrossRefPubMed

26.

Horwitz LI, Meredith T, Schuur JD, Shah NR, Kulkarni RG, Jenq GY. Dropping the Baton: a qualitative analysis of failures during the transition from emergency department to inpatient care. Ann Emerg Med. 2009;53(6):701–10.CrossRefPubMed

Title: Hand-off Education and Evaluation: Piloting the Observed Simulated Hand-off Experience (OSHE)
Authors: Jeanne M. Farnan, MD, MHPE
J. A. M. Paro, BA
R. M. Rodriguez, BA
S. T. Reddy, MD
L. I. Horwitz, MD, MPH
J. K. Johnson, MSPH, PhD
V. M. Arora, MD, MAPP
Publication date: 01-02-2010
Publisher: Springer-Verlag
Published in: Journal of General Internal Medicine / Issue 2/2010
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-009-1170-y

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Aim

Setting

Program description

Program evaluation

Discussion

Please log in to get access to this content

Other articles of this Issue 2/2010

Examining Patient Conceptions: A Case of Metastatic Breast Cancer in an African American Male to Female Transgender Patient

Unintended Pregnancy Influences Racial Disparity in Tubal Sterilization Rates

Crushed Dreams

Bat-Associated Leptospirosis

Erectile Dysfunction Drug Receipt, Risky Sexual Behavior and Sexually Transmitted Diseases in HIV-infected and HIV-uninfected Men

Authors Reply

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

At a glance: The STEP trials