Medical Education, Kirklands Hospital, Bothwell, South Lanarkshire, UK
Medical Education, Kirklands Hospital, Bothwell, South Lanarkshire, UK.
BMJ Open. 2020 Feb 12;10(2):e034468. doi: 10.1136/bmjopen-2019-034468.
Poor communication between healthcare professionals is recognised as accounting for a significant proportion of adverse patient outcomes. In the UK, the General Medical Council emphasises effective handover (handoff) as an essential outcome for medical graduates. Despite this, a significant proportion of medical schools do not teach the skill.
This study had two aims: (1) demonstrate a need for formal handover training through assessing the pre-existing knowledge, skills and attitudes of medical students and (2) study the effectiveness of a pilot educational handover workshop on improving confidence and competence in structured handover skills.
Students underwent an Objective Structured Clinical Examination style handover competency assessment before and after attending a handover workshop underpinned by educational theory. Participants also completed questionnaires before and after the workshop. The tool used to measure competency was developed through a modified Delphi process.
Medical education departments within National Health Service (NHS) Lanarkshire hospitals.
Forty-two undergraduate medical students rotating through their medical and surgical placements within NHS Lanarkshire enrolled in the study. Forty-one students completed all aspects.
Paired questionnaires, preworkshop and postworkshop, ascertained prior teaching and confidence in handover skills. The questionnaires also elicited the student's views on the importance of handover and the potential effects on patient safety. The assessment tool measured competency over 12 domains.
Eighty-three per cent of participants reported no previous handover teaching. There was a significant improvement, p<0.0001, in confidence in delivering handovers after attending the workshop. Student performance in the handover competency assessment showed a significant improvement (p<0.05) in 10 out of the 12 measured handover competency domains.
A simple, robust and reproducible intervention, underpinned by medical education theory, can significantly improve competence and confidence in medical handover. Further research is required to assess long-term outcomes as student's transition from undergraduate to postgraduate training.
医疗保健专业人员之间沟通不畅被认为是导致患者不良预后的一个重要原因。在英国，医学委员会强调有效的交接班（交班）是医学毕业生的重要成果。尽管如此，还是有相当一部分医学院没有教授这项技能。
本研究有两个目的：（1）通过评估医学生现有的知识、技能和态度，证明需要进行正式的交班培训；（2）研究试点教育交班工作坊在提高结构化交班技能的信心和能力方面的有效性。
学生在参加基于教育理论的交班工作坊之前和之后接受了客观结构化临床考试（OSCE）式交班能力评估。参与者还在工作坊前后完成了问卷调查。用于衡量能力的工具是通过修改德尔菲法（Delphi method）过程开发的。
NHS 拉纳克郡医院的医学教育部门。
42 名在 NHS 拉纳克郡轮转的本科医学生参加了这项研究，他们在轮转期间完成了医学和外科实习。41 名学生完成了所有的环节。
配对问卷，在课前和课后，确定之前在交接班技能方面的教学和信心。调查问卷还征集了学生对交接班重要性的看法以及对患者安全的潜在影响。评估工具测量了 12 个领域的能力。
83%的参与者报告没有接受过交班教学。参加工作坊后，交班信心显著提高（p<0.0001）。学生在交班能力评估中的表现，在 12 个测量的交班能力领域中，有 10 个显著提高（p<0.05）。
一个简单、可靠且可重复的干预措施，以医学教育理论为基础，可以显著提高医学交班的能力和信心。需要进一步研究，以评估学生从本科培训过渡到研究生培训后的长期效果。
