Learner handover: Perspectives and recommendations from the front-line

Abstract

Introduction Current medical education models increasingly rely on longitudinal assessments to document learner progress over time. This longitudinal focus has re-kindled discussion regarding learner handover—where assessments are shared across supervisors, rotations, and educational phases, to support learner growth and ease transitions. The authors explored the opinions of, experiences with, and recommendations for successful implementation of learner handover among clinical supervisors. Methods Clinical supervisors from five postgraduate medical education programs at one institution completed an online questionnaire exploring their views regarding learner handover, specifically: potential benefits, risks, and suggestions for implementation. Survey items included open-ended and numerical responses. The authors used an inductive content analysis approach to analyze the open-ended questionnaire responses, and descriptive and correlational analyses for numerical data. Results Seventy-two participants completed the questionnaire. Their perspectives varied widely. Suggested benefits of learner handover included tailored learning, improved assessments, and enhanced patient safety. The main reported risk was the potential for learner handover to bias supervisors’ perceptions of learners, thereby affecting the validity of future assessments and influencing the learner’s educational opportunities and well-being. Participants’ suggestions for implementation focused on who should be involved, when and for whom it should occur, and the content that should be shared. Discussion The diverse opinions of, and recommendations for, learner handover highlight the necessity for handover to maximize learning potential while minimizing potential harms. Supervisors’ suggestions for handover implementation reveal tensions between assessment-of and for-learning.

Learner handoffs: Attitudes and practices of pediatric hospitalist educators

“…And while further studies are needed to expand on this, the potential that LHs may have an impact on clinical patient care aligns with the notion that optimal medical education can and should "improve learner outcomes in order to improve patient outcomes" (Babbott, 2010). These findings are in line with a recent single institution multi-specialty study in Canada of clinical supervisors that reported potential benefits of LHs in tailored teaching, improved assessments, and enhanced patient safety (Gumuchian et al, 2020). Our data adds further validity and generalizability to these findings, while also quantifying specific practices of educators with regard to delivery, receipt, and institutional practices towards LHs.…”

“…These findings contribute to the previous debate in the literature regarding the risks of sharing information, specifically with regards to the struggling learner (Pangaro, 2008). Namely, a concern for forward feeding bias, or that sharing information about trainees in the clinical setting may positively or negatively influence the oncoming supervisor, is a large barrier to LH utilization (Gumuchian et al, 2020).…”

“…By creating a consistent and more objective tool, we also hope to focus the polymotivation for engaging in LHs (Humphrey-Murto et al, 2020) as well as to limit barriers to honest feedback (Pangaro, 2008) and thus minimize any potential negative consequences of sharing information. The role of the leaner in the handoff process, as well as who should have access to the LH information, must also be determined, echoing comments found in the recent literature (Gumuchian et al, 2020).…”

“…Given the frequency of inpatient faculty supervisor transitions, pediatric hospitalists frequently must decide whether and how to handover learners to the oncoming supervisor. However, little is known about the utilization and variability of LHs (Fuchs et al, 2020;Babbott, 2010;Warm et al, 2017;Gumuchian et al, 2020). With pediatric hospitalists' frontline role in pediatric education (Freed, Dunham and Lamarand, 2009;Fromme et al, 2010;Ottolini, 2014), our primary goal was to determine their experiences with and attitudes toward current LH practices during supervisory transitions.…”

How preceptors develop trust in continuity clinic residents and how trust influences supervision: A qualitative study

“…In the absence of longitudinal relationships, some preceptors described corroborating trust assessments with other preceptors. Formalizing such practices for preceptors to discuss learners' progress may help offset the challenges of limited residentpreceptor continuity, and thereby enhance teaching and supervision [33,34]. Our study also highlighted that longitudinal relationships do not always yield trust development.…”