Practicing handoffs early: Applying a clinical framework in the anatomy laboratory

Abstract

The anatomy laboratory provides an ideal environment for the integration of clinical contexts as the willed-donor is often regarded as a student's "first patient." This study evaluated an innovative approach to peer teaching in the anatomy laboratory using a clinical handoff context. The authors introduced the "Situation, Background, Assessment, Recommendation" (SBAR) handoff framework within the anatomy laboratory. Study participants included 147 second-year medical students completing the head and neck portion of an anatomy course. The authors used mixed methods to evaluate the impact of the anatomic SBAR on the student anatomy laboratory experience. Qualitative analysis of student evaluations revealed three themes which emerged from students' summaries of their anatomic handoff experiences: Learning-by-teaching; Acquiescing to doing more with less; and Distrust of the peer handoff process. All the themes demonstrated that the anatomic handoff encouraged students' focus on the knowledge preparation and reflection. Closed question analysis suggested that that students' perceptions of handoff usefulness were tied to deeper learning strategies. The handoff provided a mechanism for promoting students' focus on anatomical relationships and facilitated students' learning of transferable clinical skills. Together, these results suggest that the introduction of a handoff process in anatomy education provided both a mechanism for learning anatomy and a unique opportunity for early exposure to an essential clinical skill. This clinical and basic science integration may serve as a vertical integration thread which can be woven throughout undergraduate medical education. Future study will focus on exploring the long-term impacts and learning outcomes of this integration. Anat Sci Educ 9: 476-487. © 2016 American Association of Anatomists.

Patient Handoff Education: Are Medical Schools Catching Up?

“…Although medical school leaders have recognized the importance of handoff education, there has been resistance to including more formal handoff training. 18,19 Recently, some medical schools are incorporating handoff education in their curricula, 1,[20][21][22][23][24][25][26] an increase demonstrated in the present study. Some of the skills needed to develop expected behaviors of entrustable learners are being taught.…”

“…Indeed, many studies of medical school handoff curricula include practice or role play. [20][21][22][23][24][25][26] The present study yielded a statistically significant increase over time in reported use of role play (P < .0001) for handoff education. However, only half of all respondents (50%), a number that has not changed appreciably over time, report having practice as an instruction method.…”

“…For instance, the literature shows that some medical schools now provide a handoff template, mnemonic, or checklist [20][21][22]26 for educating students (entrustable behavior 1), and others provide a pocket card or handout with tips on how to deliver a good handoff. 23,24 In 2016, 43% of the respondents reported using a standardized template for shift-to-shift handoffs in medical school (an increase from 22% in 2012), and 43% reported use of a mnemonic.…”

“…One study developed instruction for both the handoff giver and receiver. 20 Another study evaluated a real patient handoff performed by a fourth-year medical student. 23 Yet another included a nurses' station with typical noises and interruptions in their simulation training.…”

The Relationship Between Anatomical Self-efficacy and Feelings of Burnout in First-year Medical Students

“…Anatomy instructors can tackle the issues of students feeling little confidence in their ability to use anatomical knowledge in a clinical setting and in their ability to answer questions in the dissection lab through intentional course design. For example, Lazarus et al [ 33 ] incorporated anatomically adapted versions of a clinical Situation, Background, Assessment, and Recommendation (SBAR) handoff oral report in their medical gross anatomy dissection lab. Students felt that the SBARs were useful and promoted deeper learning of anatomy [ 33 ].…”