Using Simulated Handover to Assess Team-Based Competencies in a Virtual Environment
TimeThursday, April 152:00pm - 3:00pm EDT
LocationEducation and Simulation
Communication and teamwork are two of the ten human factor topics identified by the World Health Organization that influence patient safety. A patient handover is the act of transferring and taking responsibility of a patient between two or more care providers. Therefore, a structured handover is considered a communication tool. As there is a high chance of information loss or misinformation, it is important to ensure effective two-way communication during handovers. In modern medical education, simulation is widely used to enhance the quality and safety of patient care. Communication skills and teamwork competencies can be effectively taught in a safe simulated setting. This study assessed a group of pre-clinical students’ performance on simulated patient handovers in a virtual environment supplemented with pre-recorded, simulated patient scenarios. This approach can be implemented by other educational institutions to take advantage of these hybrid (virtual + simulated) designs in their patient handover training.
“Transition to Clerkship” (TTC) is a course for second year undergraduate medical students at the University of Texas Southwestern Medical Center in Dallas to prepare them for the clinical environment. “Introduction to Communication” is a module in TTC that focuses on strengthening team-based communication skills through three competencies: structured communication, closed-loop communication (CLC), and clarifying questions. TTC was intended to be conducted as an in-person event within the simulation center; however, due to high rise of COVID-19 cases in the region, our team had to quickly move to a virtual platform. This quick transition from in-person to virtual learning led to many challenges, which included adjustment and modification of the curriculum, learning materials, activity design, and assessment design. Ultimately, students were provided with educational pre-work reading materials and an educational video detailing the aforementioned three competencies of team-based communication that was followed by a synchronous virtual session.
During the virtual session, 254 students (out of 257 planned) were divided into groups of 5-6 students. Each group met for approximately 45 minutes using the MS Teams platform to conduct four different simulated patient handovers. The four clinical scenarios (A, B, C, and D) for handovers were pre-recorded in the simulation center and shared with students one hour ahead of their scheduled session time. The students were asked to prepare handovers on the simulated patient scenarios that they watched prior to joining their virtual sessions. Each student in a group was randomly assigned to a role of sender, receiver, or observer of information during patient handover. Within each handover, sender refers to the transmitter of the patient information and the receiver is the recipient of the information. The rest of the students who were not either a sender or a receiver served as observers commenting on the quality of the performed handovers. In addition to the students, each session had a faculty facilitator and an evaluator.
We had 24 sessions in the morning and 24 sessions in the afternoon. We had 13 evaluators with each one evaluating a maximum of six sessions (24 handovers) and a minimum of 1 session (4 handovers). The evaluators rated seven behaviors in real time. The first 4 pertained to the use of structured communication within a patient handover to: 1) describe the clinical situation 2) provide additional background information 3) offer an assessment based on the situation and background, and 4) state a clear recommendation on what should happen. The other items pertained to closed loop communication and clarifying questions: 5) to repeat the sender’s messages, 6) to confirm or correct the recipient’s understanding of the message, and 7) to ask clarifying questions. Each behavior could receive one of three ratings. To indicate that a behavior did not occur throughout the session, evaluators selected “no/never”. To indicate if behaviors were exhibited inconsistently, evaluators chose “sometimes/somewhat”, and to indicate if behaviors were performed consistently through the session, evaluators chose “yes/always”. To foster the consistency of these ratings, the evaluators were trained on rating these behaviors through assessment guides and individual help by email, phone, and live drop-in sessions.
The total count of students in the morning and afternoon sessions were 137 and 120, respectively. Out of 192 conducted handovers (95 in the morning and 95 in the afternoon), only 2 were missed for evaluation. Thus, we had 190 recorded handovers (99% capture rate). In total, there were 48 handovers for scenarios A and C, and 47 handovers for scenarios B and D.
To ensure there were no differences in difficulty between the scenarios (A, B, C, and D), we conducted a chi square test at a 0.05 level of significance. According to the results, no significant association between patient scenarios and students’ performance was found per behavior.
According to the results, structured communication was represented 94%, 84%, 86%, and 91% of the time, respectively (for the aforementioned behaviors 1-4). Closed-loop communication was displayed 66% by the sender and 62% of the time by the recipient. Finally, clarifying questions were demonstrated in 61% of the time. In terms of behaviors not being conducted, that was mostly seen in the behaviors related to the CLC (24% and 30%) and clarifying questions (15%).
We utilized simulated patient scenarios in a virtual environment to improve students’ communication skills during handovers. To determine how students performed during the scenario, we assessed several behaviors: structured communication, closed-loop communication, and clarification questions. Results showed that the students performed stronger in the first area (structure communication) and weaker in the second (CLC) and third (clarifying question) areas.