Improving Skill Confidence on Handovers in Medical Education

BACKGROUND: Communication breakdowns during handovers contribute to adverse medical events. Handover errors have resulted in miscommunication of active medical problems, clinical conditions, medications, treatments, tests, and pending consults. The risk of miscommunications in handoffs have been suggested to be most common for novice clinicians, and 59% of residents report at least one incident of patient harm related to handoff errors. Problem patient care situations could have been anticipated during sign-out in as many as 33 of 49 cases, if potentially useful information had been communicated to allow the oncoming staff to prepare for such circumstances. Only 8% of medical schools formally teach patient handovers; however, early studiesinvestigating the effectiveness of handover interventions in medical education are promising. A didactic course and practicum on patient handovers has been shown to increase medical students’ confidence in performing handovers. Similar programs have demonstrated an increase in interns’ confidence in performing handoffs, read-backs, and making contingency plans. Although improvement in performance is a primary goal in handover education, there is evidence that skill confidence, (i.e., self-efficacy) is positively related to performance. For instance, studies have demonstrated that self-efficacy is associated with improvements of academic performance and higher exam scores. Meta-analyses report that self-efficacy accounts for about 14% of the variance in students’ academic performance. Increasing the level of confidence and behavioral performance of handovers is imperative to medical education. Given the challenges in medical practice for performing effective handoffs, the lack of formal handover education, and the limited empirical investigation; this study aims to broaden the understanding of handover education by examining the effect of an interactive classroom-based training session on patient handovers given to medical students. In particular, this study examines students’ skill confidence in written and verbal handovers on simulated handovers. While this issue has been examined in previous studies, it has not been determined if handover training improves skill confidence for performing both written and verbal handovers.METHODS: Twenty-eight rising 3rd year medical students received a three hour classroom-based training session on patient handovers, including a didactic lecture, simulated video examples, and a live role play. The lecture focused on importance and purpose of the handover process, the need for active involvement of both theoutgoing and incoming physicians, and introduced the I-SWITCH handover algorithm. Students were assessed on their skill confidence in performing both written and oral handovers before and after the classroom training session. Skill confidence was assessed via a self-report questionnaire, with ratings from 1 (strongly disagree)to 7 (strongly agree).RESULTS: To determine if the classroom training had a significant impact on students’ confidence, a paired-samples t- test was conducted for the 10 students who elected to participate. Post-training, students were significantly more confident in performing handovers, t(9)=-10.14, P\u3c .05. Specifically, students were significantly more confident in their ability to complete a written handover t(9)=-7.96, P \u3c.05 as well as verbal handovers, t(9)=-7.00, P\u3c .05.CONCLUSION: Accurate handovers are vital in the provision of quality patient care, yet breakdowns in handover communications maintain a predominant contributor in patient errors for clinicians. Handovers are rarely embedded into medical education and the current handover education curriculum lacks standardization andvalidation. Consequently, there is a need to better understand and implement handover training. This study sought to determine the effectiveness of a newly developed interactive classroom-based handover training session, and the results suggest that the handover training session significantly increased medical students’ skill confidence in performing written and verbal patient handovers. Although enhancing performance is ideal, there is merit in improving confidence considering the strong connection found by previous researchers