Systematic Training in Internal Medicine-Pediatrics End of Residency Handoffs: Residency Director Attitudes and Perceived Barriers

Background: It is unclear why systematic training in end-of-residency clinic handoffs is not universal. Purposes: We assessed Internal Medicine-Pediatrics (Med-Peds) residency program directors’ attitudes regarding end-of-residency clinic handoff systems and perceived barriers to their implementation. Methods: We surveyed all Med-Peds program directors in the United States about end-of-residency outpatient handoff systems. Results: Program directors rated systems as important (81.5%), but only 31 programs (46.3%) utilized them. Nearly all programs with (29/31 93.5%]), and most programs without systems (24/33 72.7%]) rated them as important. Programs were more likely to have a system if the program director rated it important (p = .049), and less likely if they cited a lack of faculty interest (p = .023) or difficulty identifying residents as primary providers (p = .04). Conclusions: Most program directors believe it important to formally hand off outpatients. Barriers to establishing handoff systems can be overcome with modest curricular and cultural changes.