ABSTRACT
BACKGROUND
Teaching hospitals increasingly rely on transfers of patient care to another physician (hand-offs) to comply with duty hour restrictions. Little is known about the impact of hand-offs on medical students.
OBJECTIVE
To evaluate the impact of hand-offs on the types of patients students see and the association with their subsequent Medicine Subject Exam performance.
DESIGN
Observational study over 1 year.
PARTICIPANTS
Third-year medical students in an Inpatient Medicine Clerkship at five hospitals with night float systems.
MEASUREMENTS
Primary outcome: Medicine Subject Exam at the end of the clerkship; explanatory variables: number of fresh (without prior evaluation) and hand-off patients, diagnoses, subspecialty patients, and full evaluations performed during the clerkship, and United Stated Medical Licensing Examination (USMLE) Step I scores.
MAIN RESULTS
Of the 2,288 patients followed by 89 students, 990 (43.3%) were hand-offs. In a linear regression model, the only variables significantly associated with students’ Subject Exam percentile rankings were USMLE Step I scores (B = 0.26, P < 0.001) and the number of full evaluations completed on fresh patients (B =0.20, P = 0.048; model r 2 = 0.58). In other words, for each additional fresh patient evaluated, Subject Exam percentile rankings increased 0.2 points. For students in the highest quartile of Subject Exam percentile rankings, only Step I scores showed a significant association (B = 0.22, P = 0.002; r 2 = 0.5). For students in the lowest quartile, only fresh patient evaluations demonstrated a significant association (B = 0.27, P = 0.03; r 2 = 0.34).
CONCLUSIONS
Hand-offs constitute a substantial portion of students’ patients and may have less educational value than “fresh” patients, especially for lower performing students.
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Acknowledgements
The authors acknowledge Kevin R. McCormick, MD (Highland Hospital), Walter Polashenski, MD (Rochester General Hospital), Philip Bonanni, MD (Unity Health), and Alan Kozak, MD (Mary Imogene Bassett Hospital) for their contributions to the data collection. There was no funding for this study.
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An abstract from this paper was presented at the Clerkship Directors in Internal Medicine National Conference in October 2007 and is published in the proceedings of that conference.
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Lang, V.J., Mooney, C.J., O’Connor, A.B. et al. Association Between Hand-off Patients and Subject Exam Performance in Medicine Clerkship Students. J GEN INTERN MED 24, 1018–1022 (2009). https://doi.org/10.1007/s11606-009-1045-2
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DOI: https://doi.org/10.1007/s11606-009-1045-2