C3 - 07: ENTRUSTING INTERNS WITH THE PATIENT HANDOVER: HOW HELPFUL IS SIMULATED PERFORMANCE EVALUATION?
Ayalivis De La Rosa1, Shabnam Hafiz, MD2, Shawna Kettyle, MD2, Anagha Kumar3, Shimae Fitzgibbons, MD, MEd4; 1Georgetown University Medical Center, 2MedStar Washington Hospital Center, 3MedStar Health Research Institute, 4MedStar Georgetown University Hospital
Purpose: One consequence of resident duty hour restrictions has been increased attention to the patient handover, underscored by one of the American Association of Medical Colleges’ (AAMC) Entrustable Professional Activities (EPAs): the ability to “give or receive a patient handover to transition care responsibility.” While simulation based training and standardized handover tools have been widely developed, few studies have explored the predictability of performance in a simulated handover to subsequent ‘real world’ performance. This study looks at the ability of intern performance in a simulated handover exercise to predict subsequent real-world clinical handover performance.
Methods: IRB approval was obtained and interns from five surgical specialties across two hospitals participating in an intern pre-clinical orientation were approached for enrollment. Participants proceeded through a simulated “rounding and handover” exercise: receiving a model handover from a senior resident or faculty, rounding on a standardized patient and presenting their findings to their proctor, and then performing a patient handover to a second intern (who then proceeded through the same exercise). Each intern completed two rounds of the exercise, with each round ending in a 10-15 minute EPA-based checklist feedback session. Over the subsequent three weeks, interns were evaluated by a single trained observer using the same checklist to score their clinical patient handovers. The predictive ability of the simulated handover performance score was analyzed using univariate linear regression.
Results: 34 out of a total of 35 interns were enrolled and completed the handover simulation (one intern did not have documented checklist completion). 17 of the 34 interns were subsequently observed during a clinical patient handover. The mean score for performance during the simulation was 6.0 (SD 1.47) vs. 5.82 (SD 1.24) in the live hospital setting. The performance score in the simulated setting was predictive of the interns’ performance score during a hospital clinical handover (p = 0.002).
Conclusion: A simulation based assessment of surgical interns’ ability to perform a consistent and adequate patient handover was predictive of their subsequent observed in-hospital performance, and may be considered for evaluation of the entrustability of interns with respect to this EPA.