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.
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Acknowledgements
We would like to thank the Academy of Distinguished Medical Educators at the University of Chicago Pritzker School of Medicine, which made this course possible. We would also like to thank Kris Slawinksi and Andy Bowyer for their technical assistance in the Clinical Performance Center. Finally, we would like to acknowledge our resident raters, Greg Behbehani, Keith Naylor, Bridget O’Brien, Tojo Thomas, Lavanaya Kondapalli, Adam Stein, Vagish Hemmige and Julie Kleczek.
Funding provided by the University of Chicago Pritzker School of Medicine Academy of Distinguished Medical Educators.
Drs. Arora and Farnan and funded by AHRQ 1 R03HS018278–01; Pritzker School of Medicine Academy of Distinguished Medical Educators and the University of Chicago Department of Medicine Medical Education and Clinical Excellence Award
Conflict of Interests
None disclosed.
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Appendix A
OSHE student education teaching slides (PDF 799 kb)
Appendix B
Standardized Hand-off mock chart (PDF 30.7 kb)
Appendix C
OSHE training goals and objectives (PDF 21.3 kb)
Appendix D
Standardized written hand-off template (PDF 12.7 kb)
Appendix E
OSHE rater training slides (PDF 867 kb)
OSHE video can be viewed at http://web.me.com/johnparo/MedSchoolRock/oshe.html]
Appendices
Appendix 1: Hand-off CEX instrument
Appendix 2: Standardized Hand-off answer key
Table 2
SCORING FOR WRITTEN SIGN-OUT:
Six-point identification data =1 point for each element in identification data
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One for each element missed or incorrect
Four-point problem list
One point for one-line summary statement with why patient is here now
Three points for problem list, 1 point for each active problem with statement of management
Five points for complete medication list (all medications, all doses, all frequencies including PRN medications)
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One point if missing over 50% doses
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One point if missing over 50% of frequencies
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One point if no PRN medications listed
Three points total for To Do:
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One point for each To Do
Two points for If/Then Statement
Twenty points total
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Farnan, J.M., Paro, J.A.M., Rodriguez, R.M. et al. Hand-off Education and Evaluation: Piloting the Observed Simulated Hand-off Experience (OSHE). J GEN INTERN MED 25, 129–134 (2010). https://doi.org/10.1007/s11606-009-1170-y
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DOI: https://doi.org/10.1007/s11606-009-1170-y