Mitigating “Educational Groundhog Day” – The Role of Learner Handoffs Within Clinical Rotations: A Survey of Pediatric Educational Leaders |
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| Institution: | 1. Department of Pediatrics (J Fuchs), University of North Carolina and NC Children''s Hospital, Chapel Hill, NC;2. Department of Pediatrics (M King), Division of General Academic Pediatrics GAP, St. Louis University School of Medicine, St. Louis, Mo;3. Department of Pediatrics (EP Devon), Perelman School of Medicine, University of Pennsylvania; The Children''s Hospital of Philadelphia, Philadelphia, Pa;4. Dan L. Duncan Institute for Clinical and Translational Research (D Guffey), Baylor College of Medicine, Houston, Tex;5. Department of Pediatrics (M Keeley), University of Virginia, Charlottesville, Va;6. Department of Pediatrics (MEM Rocha), Baylor College of Medicine, Pediatric Hospital Medicine, Houston, Tex;1. Center for Child Health Policy and Advocacy, Baylor College of Medicine (JL Raphael), Houston, Tex;2. Section of Academic General Pediatrics, Baylor College of Medicine (JL Raphael), Houston, Tex;3. Child Health Advocacy Institute, Children''s National Health System (LS Beers), Washington, DC;4. Department of Pediatrics, Mass General Hospital for Children, Harvard Medical School (JM Perrin), Boston, Mass;5. Department of Pediatrics, Boston Medical Center/Boston University School of Medicine (A Garg), Boston, Mass;1. Department of Health Management and Policy (AN Ortega, JK Pintor, CK Alberto), Dornsife School of Public Health, Drexel University, Philadelphia, Pa;2. Department of Health Policy and Management (DH Roby), School of Public Health, University of Maryland, College Park, Md;1. Division of General Pediatrics (N Stavas and J Wood);2. Center for Pediatric Clinical Effectiveness and PolicyLab (N Stavas, C Paine, L Song, J Shults, and J Wood), The Children''s Hospital of Philadelphia;3. Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania (N Stavas and J Wood), Philadelphia;1. Department of Pediatrics, MassGeneral Hospital for Children (AS Frey-Vogel and K Dzara), Boston, Mass;2. Department of Pediatrics, Dartmouth-Hitchcock Medical Center (KA Gifford), Lebanon, NH;3. Department of Pediatrics, Hasbro Children''s Hospital (EY Chung), Providence, RI;4. Harvard Medical School (AS Frey-Vogel and K Dzara), Boston, Mass;5. The Warren Alpert Medical School of Brown University (EY Chung), Providence, RI;6. Geisel School of Medicine at Dartmouth (KA Gifford), Hanover, NH;1. Division of Bioethics and Palliative Care, Seattle Children''s Hospital and University of Washington (A Trowbridge), Seattle, Wash;2. Pediatric Advanced Care Team, The Children''s Hospital of Philadelphia (T Bamat, E McConathey, C Feudtner, and JK Walter), Philadelphia, Pa;3. PolicyLab, The Children''s Hospital of Philadelphia (H Griffis), Philadelphia, Pa;4. Department of Medical Ethics, The Children''s Hospital of Philadelphia (C Feudtner and JK Walter), Philadelphia, Pa |
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| Abstract: | BackgroundMedical students decry frequent changes in faculty supervision, leading to the experience of “educational groundhog day.” The discontinuity in supervision, cursory relationships, and uncoordinated feedback impede students’ skill acquisition and delay entrustment decisions. Whereas patient handoff bundles are common, little is known about similarly structured approaches to learner handoffs (LHs).ObjectiveTo describe current LH procedures and practices within pediatric clerkships and subinternships and to gauge interest in a future LH bundle.MethodsNine items included in the 2016 Council on Medical Student Education in Pediatrics annual member survey were analyzed using mixed-methods.ResultsThe response rates were 66% (101 of 152) and 40% (165 of 411) for institutions and individuals, respectively. After limiting data to complete responses to programs with traditional block rotations, 54% of individual respondents (76 of 141) identified as inpatient faculty and about a quarter endorsed providing LHs. Inpatient faculty most commonly supervise medical students for 5 to 7 days. Most endorsed needing 1 to 3 days to determine a student's baseline performance and 5 days or more to make entrustment decisions. Three-quarters of inpatient faculty endorsed interest in LHs, while fewer than 16% of course directors currently provide LH expectations. Four themes emerged: instrument features, stakeholder buy-in, impact, and utility.ConclusionsTypical inpatient faculty service days approximate the time required for making entrustment decisions about clinical students. While most inpatient faculty desire a LH bundle for use within a clinical rotation, few institutions and faculty currently use LHs. LHs could accelerate entrustment decisions by allowing coordinated feedback that might hasten learner clinical-skill development. |
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