Learner handoffs: Attitudes and practices of pediatric hospitalist educators

Abstract

Introduction: Communication failures during frequent transitions in attending supervision can lead to delayed entrustment, uncoordinated feedback, and arrested professional development for trainees. With structured patient handoffs showing promise in patient outcomes, attention has been paid to learner handoffs (LHs), though little is known about their utilization and effectiveness. The aim of this study was to identify attitudes and practices of pediatric hospitalist educators towards LHs.Methods: An anonymous electronic survey was distributed to members of the American Academy of Pediatrics (AAP) Pediatric Hospital Medicine Educator Listserv. Data was analyzed using mixed-methods.Results: Of 584 eligible educators, 129 (22%) responded. Most respondents (78%) were familiar with LHs, though only 30% reported that they were an expectation of their pediatric hospitalist groups. Only 15% reported using a structured format, and only 10% of educators received any formal training. A handoff of each additional learner was reported to add less than 5 minutes to the overall handoff. The vast majority reported LHs improved their ability to give accurate feedback (93%) and to tailor teaching (89%), while almost half (46%) reported LHs improved patient care. Major qualitative themes for advantages of LHs included better understanding learner capabilities, learner goals/attending expectations, and optimizing feedback. Barriers to implementation included time constraints and potential for bias.Discussion: Despite overwhelmingly positive views regarding teaching and feedback, LHs often remain unstructured, unexpected, and delivered by untrained supervisors. The development of a structured LH tool, in conjunction with faculty buy-in and training, may accelerate trainee professional development, while mitigating any concerns for added bias.

Learner Handoffs Within Clinical Rotations: From the Resident Perspective

“…Specifically, LHs were perceived to accelerate the entrustment process, optimize the approach of the attending physician to meet the needs of the learner, improve the clinical performance of the learner, and protect patient safety through identification and communication of professionalism or clinical concerns. 10,12,13,16,20 Although research on information transfer regarding learners has mostly focused on the struggling learner, 17–19 participants in our study recognized LHs’ ability to identify actionable feedback and enable constructive coaching for the exceptional learner as well. LHs may have broader application than only for the learner who is not meeting expectations.…”

“…However, the biggest obstacle to uptake remains the concern for further propagating bias within medical education, voiced by learners and educators alike. 10,13,15,16,19,20,27 CBME's reliance on frequent longitudinal assessment thus places LHs in a difficult position-effective information transfer is required, but how will the risk of bias affect equitable assessment? Participants feared that the gossip-like nature of LHs would lead to stigmatized learners and biased assessors, a fear that may be exacerbated by the social and therapeutic motivations for LHs reported by clinical faculty.…”

“…We used previous literature to help inform the development of the focus group interview guide (see Supplemental Digital Appendix 1 at http://links.lww.com/ACADMED/B367). 10,16,20 Focus group facilitators held no programmatic or evaluative role for the residents with whom they interacted (Harbor-UCLA [M.D.F. ], University of Chicago [A.S.W.…”

“…com/ACADMED/B367). 10,16,20 During the focus groups, we provided participants with the research definition of LHs to ensure shared mental framing and subsequently asked about their prior knowledge of LHs and their understanding of the purpose of LHs. We then asked a series of open-ended questions to probe the participants' perceived benefits and risks with respect to trainees, faculty, and patients.…”

“…10 Despite these positive perceptions, however, the uptake of LHs has been inconsistent, with several studies demonstrating that a minority of programs and educators routinely or formally use this practice, and when they do, it is mostly in the context of discussing struggling learners. [14][15][16] This infrequent use may be linked to significant concerns surrounding biasing the oncoming attending or stigmatizing learners, referred to as feed-forward bias. 10,12,13,[16][17][18][19] Together, LHs may not only improve information transfer and longitudinal assessment, core tenets of CBME, but also further propagate biased assessments.…”