A novel curriculum to train physician assistant students how to write effective discharge summaries

Abstract

Background: Physician assistants (PAs) are an integral part of inpatient care teams, but many PAs do not receive formal education on authoring discharge summaries. High-quality discharge summaries can mitigate patient risk during transitions of care by improving interprovider communication. Objective: To understand the current state of discharge summary education at our institution, and describe a novel curriculum to teach PA students to write effective discharge summaries. Design: Students completed a pre-survey to assess both knowledge and comfort levels regarding discharge summaries. They wrote a discharge summary and received feedback from two evaluators, an inpatient provider (IPP) familiar with the described patient and a simulated primary care provider (PCP). Students completed a post-survey reassessing knowledge and comfort. Results: Prior to instituting this curriculum, the majority of students (92.9%) reported rarely or never receiving feedback on discharge summaries. Eighty-four of 88 (95.5%) eligible students participated. There was discordance between IPP and simulated PCP feedback on their assessment of the quality of discharge summaries; simulated PCPs gave significantly lower global quality ratings (7.9 versus 8.5 out of 10, p = 0.006). Key elements were missing from >10% of discharge summaries. Student response was favorable. Conclusion: Clinically relevant deficiencies were common in students' discharge summaries, highlighting the need for earlier, structured training. IPPs and simulated PCPs gave discordant feedback, emphasizing differing needs of different providers during transitions of care. This novel curriculum improved students' knowledge and confidence.

Structure, content, unsafe abbreviations, and completeness of discharge summaries: A retrospective analysis in a University Hospital in Austria

“…Several issues related to the medical DS have already been identified. 6 Delayed transmission of the DS to the further treating physician, 7 , 8 , 9 low quality or lack of information, 10 , 11 lack of consistent formats, 12 , 13 , 14 lack of patient understanding, 15 , 16 and inadequate training for medical students in writing medical DS 17 are some important issues. The medical DS is not only an important document for the treating general physician (GP) but it is also relevant for other healthcare providers as well as patients and relatives.…”

Optimizing Discharge Summaries: A Multispecialty, Multicenter Survey of Primary Care Clinicians

“…[6][7][8] In addition, medical students are not trained or given feedback on discharge summaries despite evidence showing that a curriculum can improve content and confidence in discharge summaries. 9 There are many studies demonstrating the high frequency of inaccuracies or missing components from each discharge summary, most commonly within the medication section, and the summaries often are not completed before the posthospital visit. [10][11][12][13][14][15][16][17][18] Ultimately, the responsibility for thorough and timely completion as well as transmission of the discharge summary rests with the inpatient clinician and health system.…”

“…Formal training to teach residents how to write discharge summaries has traditionally been lacking 6–8 . In addition, medical students are not trained or given feedback on discharge summaries despite evidence showing that a curriculum can improve content and confidence in discharge summaries 9 . There are many studies demonstrating the high frequency of inaccuracies or missing components from each discharge summary, most commonly within the medication section, and the summaries often are not completed before the posthospital visit 10–18 .…”