Internal medicine postgraduate training and assessment of patient handoff skills

Abstract

Background: Effective communication during patient care transitions is essential for high-quality patient care.

Objective: The purpose of this study was (1) to objectively assess patient handoff skills of internal medicine residents, and (2) to evaluate correlations between clinical experience and patient handoff skill self-assessment with directly observed skill.

Methods: We studied simulated patient handoffs in postgraduate year (PGY)-1 and PGY-2 residents between July 2011 and September 2011, using a standardized scenario in an observed structured handoff exam (OSHE). Our design was a posttest-only, with nonequivalent groups. Assessment used a previously published checklist for evaluating handoff skills. Residents were asked about clinical experience with patient handoffs and about their self-confidence in performing a patient handoff independently. We evaluated between-group differences on OSHE checklist performance, patient handoff experience, and self-confidence and used multiple regression analyses to assess the association between performance, experience, and confidence.

Results: Forty-seven PGY-1 residents and 38 PGY-2 residents completed the study. Interrater reliability was substantial (intraclass correlation = 0.68). There was no significant difference in OSHE performance by PGY-1 residents (mean = 79%, SD = 4.6) and PGY-2 residents (mean = 82%; SD = 7.6; P = .07). The PGY-2 residents were significantly more experienced (P < .001) and confident (P < .001) than PGY-1 residents were, yet clinical experience and self-confidence did not significantly predict OSHE performance.

Conclusions: Clinical experience and self-assessment do not predict skills in simulated patient handoffs, and residents with substantial clinical experience still benefit from further skills development.

FIGURE 1

Resident Performance on the Objective Structured Handoff Examination (OSHE), Defined as the Percentage of the Total Score Out of the Total Possible Score, by Postgraduate Year (PGY) Status

FIGURE 2

Resident Clinical Experience, Defined as the Number of Actual Patient Handoffs Performed, by Postgraduate Year (PGY) Status

FIGURE 3

Resident Self-Confidence in Handoff Communication Skills by Postgraduate Year (PGY) Status Scale ranges from 0 (not confident) to 100 (extremely confident).