Handover training for medical students: A controlled educational trial of a pilot curriculum in Germany

Objective: The aim of this study was to implement and evaluate a newly developed standardised handover curriculum for medical students. We sought to assess its effect on students’ awareness, confidence and knowledge regarding handover. Design: A controlled educational research study. Setting: The pilot handover training curriculum was integrated into a curriculum led by the Departments of Anesthesiology and Intensive Care (AI) at the University Hospital. It consisted of three modules integrated into a 4-week course of AI. Multiple types of handover settings namely end-of-shift, operating room/postanaesthesia recovery unit, intensive care unit, telephone and discharge were addressed. Participants: A total of n=147 fourth-year medical students participated in this study, who received either the current standard existing curriculum (no teaching of handover, n=78) or the curriculum that incorporated the pilot handover training (n=69). Outcome measures: Paper-based questionnaires regarding attitude, confidence and knowledge towards handover and patient safety were used for pre-assessment and post-assessment. Results: Students showed a significant increase in knowledge (p<0.01) and self-confidence for the use of standardised handover tools (p<0.01) as well as accurate handover performance (p<0.01) among the pilot group. Conclusion: We implemented and evaluated a pilot curriculum for undergraduate handover training. Students displayed a significant increase in knowledge and self-confidence for the use of standardised handover tools and accuracy in handover performance. Further studies should evaluate whether the observed effect is sustained across time and is associated with patient benefit

The role of a checklist for assessing the quality of basic life support performance: an observational cohort study

Abstract Background Training lay rescuers in Basic Life Support (BLS) is essential to improve bystander cardiopulmonary resuscitation (CPR) rates; in addition, simple methods are needed to provide feedback on CPR performance. This study evaluated whether a simple observational checklist can be used by BLS instructors to adequately measure the quality of BLS performance as an alternative to other feedback devices. Methods The BLS performances of 152 first-year medical students (aged 21.4 ± 3.9 years) were recorded on video, and objective data regarding the quality of the BLS were documented using Laerdal PC SkillReporting software. The performances were categorized according to quality. Ten BLS instructors observed the videos and completed a ten-point checklist based on the Cardiff Test of BLS (version 3.1) to assess the performances. The validity of the checklist was reviewed using interrater reliability as well as by comparing the checklist-based results with objective performance data. Results Matching the checklist-based evaluation with the objective performance data revealed high levels of agreement for very good (82%) and overall insufficient (75%) performances. Regarding the checklist-based evaluation, interrater reliability depended on the checklist item; thus, some items were more easily identified correctly than others. The highest and lowest levels of agreement were observed for the items “undressed torso” and “complete release between compressions” (mean joint-probability 95 and 67%, respectively). Conclusions The observational checklist adequately distinguished sufficient from insufficient BLS performances and offered an assessment of items not incorporated by SkillReporting software such as the initial assessment or undressing the chest. Although its usefulness was reduced for scaling intermediate performance groups, the checklist may be overall a useful rating tool in BLS-training if objective feedback devices are not available, for example, due to large groups of participants or limited training time

Patientenübergaben in der Ausbildung?: Eine systematische Analyse des Trainingsbedarfs unter Medizinstudierenden

Hintergrund: Neben einem erhöhten Risiko für Komplikationen und Behandlungsfehler führen insuffiziente Übergaben zu Therapieverzögerungen, längeren Krankenhausaufenthalten, erhöhten Kosten und vermehrten Patientenbeschwerden. Die Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI) und der Europäische Rat für Wiederbelebung (ERC) empfehlen die Einführung eines Kommunikationsablaufs nach dem SBAR-Konzept. Bisher existieren in Deutschland kaum Anforderungen Patientenübergaben in der Ausbildung zu adressieren. Methoden: Im Rahmen des EU-geförderten Projektes PATIENT wurde eine onlinebasierte Bedarfsanalyse im Querschnittsdesign durchgeführt. In Aachen wurden 237 Medizinstudierende zu 45 Items in drei Abschnitten zum Thema Übergabeprozesse befragt. A: Fertigkeiten (Wichtigkeitsbeurteilung und Selbsteinschätzung); B: Erfahrungen aus der klinischen Praxis (Zustimmung); C: Curriculumsinhalte (Präsenz und Relevanz). Alle Items wurden mittels einer Likert-Skala (0-7) bewertet. Ergebnisse: Die adäquate Durchführung einer Patientenübergabe wurde von Studierenden bei eigener geringer Handlungskompetenz (M = 4,0; SD: ±1,3) durchschnittlich als sehr wichtig beurteilt (M = 6,8; SD: ±0,6). Ein hoher Trainingsbedarf wurde für die Items "Entlassbrief schreiben" sowie "akkurate Übergaben durchführen" erfasst. Den Zusammenhang zwischen adäquaten Patientenübergaben und Patientensicherheit erkennen die Studierenden (M = 6,5; SD: ±0,9). Sie sprechen standardisierten Übergabeprozessen im Curriculum eine hohe Bedeutung zu (M = 6,1; SD: ±1,1). Der Umgang mit medizinischen Fehlern ist aus Sicht der Studierendenden im Curriculum unterrepräsentiert (61,7%). Schlussfolgerung: Es liegt ein Trainingsbedarf für Patientenübergaben vor, insbesondere bei Verlegungen und Entlassungen. Daraus wurden Lernziele definiert, Trainingsmodule entwickelt und am Standort Aachen in die Ausbildung integriert. (DIPF/Orig.)Background: Insufficient handoffs lead to an increase in the risk of complications and malpractice, treatment delays, prolonged hospital stays, costs and patient complaints. The German Society for Anesthesiology and Intensive Care (DGAI) and the European Resuscitation Council (ERC) recommend the implementation of a communication procedure according to the SBAR concept. So far, there have been few curricular requirements in Germany regarding handoffs. Methods: As part of the EU-funded PATIENT project an online-based cross-sectional needs analysis was conducted in three countries. In Aachen, 237 medical students answered 45 items concerning handoffs in three sections: A: skills (relevance and self-assessment), B: clinical experience (agreement), C: curricula content (presence and relevance). Data was recorded using a Likert scale (0-7). Results: The students rated an adequate handoff performance as highly important (M = 6.8; SD: ±0.6) and their own expertise as low (M = 4.0; SD: ±1.3). A high training need was identified for writing discharge letters and performing accurate handoffs. The students were aware of the link between adequate handoffs and patient safety (M = 6.5; SD: ±0.9). They considered standardized handoff procedures as an important curricular component (M = 6.1; SD: ±1.1). From their point of view, the handling of medical errors is underrepresented in the curriculum (61.7 %). Conclusion: A need for handoff training was revealed, especially regarding transfers and discharges. Accordingly, learning objectives were determined and training modules developed and integrated into the curriculum in Aachen. (DIPF/Orig.

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Data from: Handover training for medical students – a controlled educational trial of a pilot curriculum

Background: Handovers are a critical point of patient care and a significant source of adverse events. The WHO patient safety curriculum provides some structure for handover teaching; in Europe, there is no standardized curriculum for undergraduate handover training. To address this, the Aachen Interdisciplinary Training Centre for Medical Education, developed and established a pilot curriculum for handover training in the context of the EU-funded PATIENT-project Objective: To develop and implement a handover curriculum for medical students and to assess its effect on students’ awareness, confidence and knowledge regarding patient safety and handover in multiple settings. Methods: The pilot handover training curriculum was designed following Kern´s principles of curriculum development and was integrated into a curricular course led by departments for anesthesiology and intensive care (AI) at the University Hospital. A controlled educational research study was conducted with 4th year medical students (n=147) who either received the standard existing curriculum (no teaching of handover, n=78) or the pilot handover training (n=69). Paper-based questionnaires regarding attitude, confidence and knowledge towards handover and patient safety were used for pre- and post-assessment. The pilot curriculum consisted of 3 units (1-2 hours each) integrated into a 4-week course of AI. Multiple types of handover (end-of-shift, operating room/post anesthesia recovery unit/ICU, telephone, discharge) were addressed. Results: Students showed a significant increase in knowledge (p<0.01) and self-confidence for the use of standardized handover tools (p<0.01) and accurate handover performance (p<0.01) among the pilot group. Discussion/Conclusion: We developed and implemented a pilot curriculum for undergraduate handover training. Students displayed a significant increase in knowledge and self-confidence for the use of standardized handover tools and accurate handover performance. An evaluation of the curriculum by other faculties is needed. Further studies should evaluate whether the observed effect of a specific handover strategy is associated with a patient benefit