Dataset Information

The Modified, Multi-patient Observed Simulated Handoff Experience (M-OSHE): Assessment and Feedback for Entering Residents on Handoff Performance.

ABSTRACT:

Background

Despite the identification of transfer of patient responsibility as a Core Entrustable Professional Activity for Entering Residency, rigorous methods to evaluate incoming residents' ability to give a verbal handoff of multiple patients are lacking.

Aim

Our purpose was to implement a multi-patient, simulation-based curriculum to assess verbal handoff performance.

Setting

Graduate Medical Education (GME) orientation at an urban, academic medical center.

Participants

Eighty-four incoming residents from four residency programs participated in the study.

Program description

The curriculum featured an online training module and a multi-patient observed simulated handoff experience (M-OSHE). Participants verbally "handed off" three mock patients of varying acuity and were evaluated by a trained "receiver" using an expert-informed, five-item checklist.

Program evaluation

Prior handoff experience in medical school was associated with higher checklist scores (23% none vs. 33% either third OR fourth year vs. 58% third AND fourth year, p?=?0.021). Prior training was associated with prioritization of patients based on acuity (12% no training vs. 38% prior training, p?=?0.014). All participants agreed that the M-OSHE realistically portrayed a clinical setting.

Conclusions

The M-OSHE is a promising strategy for teaching and evaluating entering residents' ability to give verbal handoffs of multiple patients. Prior training and more handoff experience was associated with higher performance, which suggests that additional handoff training in medical school may be of benefit.

SUBMITTER: Gaffney S

PROVIDER: S-EPMC4803693 | biostudies-literature | 2016 Apr

REPOSITORIES: biostudies-literature

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Publications

The Modified, Multi-patient Observed Simulated Handoff Experience (M-OSHE): Assessment and Feedback for Entering Residents on Handoff Performance.

Gaffney Sean S Farnan Jeanne M JM Hirsch Kristen K McGinty Michael M Arora Vineet M VM

Journal of general internal medicine 20160129 4

<h4>Background</h4>Despite the identification of transfer of patient responsibility as a Core Entrustable Professional Activity for Entering Residency, rigorous methods to evaluate incoming residents' ability to give a verbal handoff of multiple patients are lacking.<h4>Aim</h4>Our purpose was to implement a multi-patient, simulation-based curriculum to assess verbal handoff performance.<h4>Setting</h4>Graduate Medical Education (GME) orientation at an urban, academic medical center.<h4>Particip ...[more]

PMID: 26831306

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Project description:BACKGROUND:Multisource feedback (MSF) is increasingly being used to assess trainee performance, with different assessor groups fulfilling a crucial role in utility of assessment data. However, in health professions education, research on assessor behaviors in MSF is limited. When assessing trainee performance in work settings, assessors use multidimensional conceptualizations of what constitutes effective performance, also called personal performance theories, to distinguish between various behaviors and sub competencies., This may not only explain assessor variability in Multi Source Feedback, but also result in differing acceptance (and use) of assessment data for developmental purposes. The purpose of this study was to explore performance theories of various assessor groups (residents and nurses) when assessing performance of residents. METHODS:A constructivist, inductive qualitative research approach and semi-structured interviews following MSF were used to explore performance theories of 14 nurses and 15 residents in the department of internal medicine at Aga Khan University (AKU). Inductive thematic content analysis of interview transcripts was used to identify and compare key dimensions in residents' and nurses' performance theories used in evaluation of resident performance. RESULTS:Seven major themes, reflecting key dimensions of assessors' performance theories, emerged from the qualitative data, namely; communication skills, patient care, accessibility, teamwork skills, responsibility, medical knowledge and professional attitude. There were considerable overlaps, but also meaningful differences in the performance theories of residents and the nurses, especially with respect to accessibility, teamwork and medical knowledge. CONCLUSION:Residents' and nurses' performance theories for assessing resident performance overlap to some extent, yet also show meaningful differences with respect to the performance dimensions they pay attention to or consider most important. In MSF, different assessor groups may therefore hold different performance theories, depending on their role. Our results further our understanding of assessor source effects in MSF. Implications of our findings are related to implementation of MSF, design of rating scales as well as interpretation and use of MSF data for selection and performance improvement.

Project description:BackgroundHigh-fidelity patient simulation has been praised for its ability to recreate lifelike training conditions. The degree to which high fidelity simulation elicits acute emotional and physiologic stress among participants - and the influence of acute stress on clinical performance in the simulation setting - remain areas of active exploration. We examined the relationship between residents' self-reported anxiety and a proxy of physiologic stress (heart rate) as well as their clinical performance in a simulation exam using a validated assessment of non-technical skills, the Ottawa Crisis Resource Management Global Rating Scale (Ottawa GRS).MethodsThis was a prospective observational cohort study of emergency medicine residents at a single academic center. Participants managed a simulated clinical encounter. Anxiety was assessed using a pre- and post-simulation survey, and continuous cardiac monitoring was performed on each participant during the scenario. Performance in the simulation scenario was graded by faculty raters using a critical actions checklist and the Ottawa GRS instrument.ResultsData collection occurred during the 2011 academic year. Of 40 eligible residents, 34 were included in the analysis. The median baseline heart rate for participants was 70 beats per minute (IQR: 62 - 78). During the simulation, the median maximum heart rate was 140 beats per minute (IQR: 137 - 151). The median minimum heart rate during simulation was 81 beats per minute (IQR: 72 - 92), and mean heart rate was 117 beats per minute (95% CI: 111 - 123). Pre- and post-simulation anxiety scores were equal (mean 3.3, IQR: 3 to 4). The minimum and maximum Overall Ottawa GRS scores were 2.33 and 6.67, respectively. The median Overall score was 5.63 (IQR: 5.0 to 6.0). Of the candidate predictors of Overall performance in a multivariate logistic regression model, only PGY status showed statistical significance (P = 0.02).ConclusionsSimulation is associated with physiologic stress, and heart rate elevation alone correlates poorly with both perceived stress and performance. Non-technical performance in the simulation setting may be more closely tied to one's level of clinical experience than to perceived or actual stress.

Dataset Information

The Modified, Multi-patient Observed Simulated Handoff Experience (M-OSHE): Assessment and Feedback for Entering Residents on Handoff Performance.

Background

Aim

Setting

Participants

Program description

Program evaluation

Conclusions

Publications

The Modified, Multi-patient Observed Simulated Handoff Experience (M-OSHE): Assessment and Feedback for Entering Residents on Handoff Performance.

Similar Datasets

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