Participation and experience of third-year medical students in handoffs: time to sign out?

ABSTRACT

BACKGROUND: Although interns are expected to be competent in handoff communication, it is currently unclear what level of exposure, participation, and comfort medical students have with handoffs prior to graduation. OBJECTIVE: The aim of this study is to characterize passive and active involvement of third-year medical students in the major components of the handoff process. DESIGN: An anonymous voluntary retrospective cross-sectional survey administered in 2010. PARTICIPANTS: Rising fourth-year students at two large urban private medical schools. MAIN MEASURES: Participation and confidence in active and passive behaviors related to written signout and verbal handoffs during participants' third-year clerkships. KEY RESULTS: Seventy percent of students (n = 204) responded. As third-year medical students, they reported frequent participation in handoffs, such as updating a written signout for a previously admitted patient (58 %). Students who reported frequent participation (at least weekly) in handoff tasks were more likely to report being confident in that task (e.g., giving verbal handoff 62 % vs. 19 %, p < 0.001). Students at one site that did not have a handoff policy for medical students reported greater participation, more confidence, and less desire for training. Nearly all students believed they had witnessed an error in written signout (98 %) and almost two-thirds witnessed an error due to verbal handoffs (64 %). CONCLUSIONS: During their third year, many medical students are participating in handoffs, although reported rates differ across training environments. Medical schools should consider the appropriate level of competence for medical student participation in handoffs, and implement corresponding curricula and assessment tools to ensure that medical students are able to effectively conduct handoffs.