Content of an Educational Handover Letter From Medical Schools to Surgery Residencies: A Mixed Method Analysis

Abstract

PurposeTo identify the content of an educational handover letter from undergraduate to graduate education in General Surgery. MethodExpert consensus was attained on the content of an educational handover letter. A 3-stage Delphi technique was employed with 8 experts in each of 4 stakeholder groups: program directors in general surgery, medical student surgical acting internship or prep course directors, authors of medical student performance evaluations, and current categorical General Surgery residents. Data were collected from April through July 2019. A mixed method analysis was performed to quantitatively assess items selected for inclusion and qualitatively provide guidance for the implantation of such a letter. ResultsAll 32 experts participated in at least one round. Of the 285 initially identified individual items, 22 were ultimately selected for inclusion in the letter. All but one expert agreed that the list represents what the content of an educational handover letter in General Surgery should be. Qualitative analysis was performed on 395 comments and identified 4 themes to guide the implementation of the letter: "minimize redundancy, optimize impact, use appropriate assessments, and mitigate risk." ConclusionsA framework and proposed template are provided for an educational handover letter from undergraduate to graduate medical education in General Surgery based on the quantitative and qualitative analysis of expert consensus of major stakeholders. This letter holds promise to enhance the transition from undergraduate to graduate medical education by allowing programs to capitalize on strengths and efficiently address knowledge gaps in new trainees.At present, the only information on medical student performance provided by medical schools to residency programs is the medical student performance evaluation (MSPE, formerly "Dean's Letter"). This evaluation has been criticized for its strong bias in favor of students, except in the few areas where truly objective data is reported, such as class standing. Even course grades can be unreliable due to grade inflation. 1,2 Despite efforts by the Association of American Medical Colleges (AAMC) to standardize the MSPE, the actual product received by residency programs is highly variable with less than ½ of U.S. and Canadian schools complying with the AAMC's recommendations. 3,4 Across these medical schools, as many as 72 different terms are used to describe the top tier of students. 5

Disruption and Dissonance: Exploring Constructive Tensions Within Research in Medical Education

“…Central to facilitating such growth were trust in supervisory relationships, opportunities to practice skills while normalizing discomfort, and fostering help seeking. 3,5,7 Within the area of assessment, long-standing challenges can now be viewed through a different contextual lens. For example, building programs of WBA or frameworks to assess professionalism requires deep and meaningful engagement with assessors and learners to co-design new systems and approaches that are contextually specific.…”

“…Lipman and colleagues developed an educational handover letter template for those applying to surgery residencies that highlighted essential components deemed useful to program directors as they onboard new residents. 7 Of the 22 elements, discernment (knowing when to ask for help) and demonstrating growth-oriented behavior were among the most important. Such insights help us align education with the nature of practice: ubiquitous and constant uncertainty.…”

“Dismantling Fixed Time, Variable Outcome Education: Abandoning ‘Ready or Not, Here they Come’ is Overdue”

“…Medical students being considered for the program expressed interest in staying at their institution for postgraduate medical education whether or not they were accepted to the pilot program [28]. Observations over a decade showed that site continuity: 1) alleviated the competition of the "Match," allowing trainees to focus on learning as opposed to vying for residency positions, 2) facilitated "responsible" educational handovers" [29,30] ensuring both strengths and areas for improvement were included in the individual learning plan going forward, and 3) obviated the need to audition for and visit other programs, eliminating prohibitive costs and lost educational time associated with these activities.…”

The American College of Surgeons Entering Resident Readiness Assessment (ACS ERRA)

“…During this period, program directors and faculty pay close attention to individual residents' strengths and weaknesses [1][2][3] and are mindful of addressing gaps in knowledge and performance, early on when needed, recognizing that timely remediation and individualized learning plans are foundational to ensuring resident success. [4][5][6][7][8][9] Studies in surgical education have documented widespread need for early assessment targeting entering residents. [10][11][12] Yet, there is a lack of rigorous formative assessment tools to help residents maintain entrustable levels of knowledge and skills during the early phase of residency.…”