Discharge summary training curriculum: a novel approach to training medical students how to write effective discharge summaries.

BACKGROUND

Resident physicians at teaching hospitals write many discharge summaries (DCSs), but receive little formal training or feedback. Poor DCS quality poses a potential patient safety risk.

METHODS

We developed a curriculum to train fourth-year medical students (MS4s) how to write DCSs and integrated this curriculum into a transition-to-residency course. An inpatient attending physician (IPA) and non-inpatient physician (coach) used structured tools to assess for the presence of key elements within the DCS, evaluate the overall quality of the DCS, and judge the student's progression towards entrustable professional activities and transitional year milestones. We identified overall areas of weakness and correlated scores between IPAs and coaches. Improvements in student knowledge and DCS writing confidence were determined using pre- and post-curriculum surveys.

RESULTS

Of 102 eligible students, 78 completed the assignment, 61 wrote a new DCS and 17 reviewed previously written DCSs. Patient condition at discharge was missing in more than 20.0% of DCSs. Coaches were less likely than IPAs to assess students as entrustable (58.3% versus 95.8%; p = 0.0027). IPAs assigned higher overall quality ratings than coaches (8.0 versus 6.0 out of 10.0, p< 0.0001). Post-intervention, 82.2% of students reported they learned how to write high-quality DCSs and 93.3% of students reported they would change the way they write DCSs.

CONCLUSIONS

Graduating medical students have limited skill and comfort in writing DCSs. Structured training on how to write DCSs before postgraduate residency training is a key step towards ultimately improving transitions of care. Training should teach learners to write high-quality DCSs that serve the needs of both inpatient and outpatient providers. Resident physicians at teaching hospitals are expected to independently author [discharge summaries] DCSs, yet few receive formal training.