Handover education in UK medical schools: Current practices and implications for educators

Dear Sir

Much evidence exists to demonstrate that poor handover can directly impact patient safety, leading to calls for formal education on this issue. Evidence to guide interventional design is limited, although examination of this evidence suggests a model for handover education consisting of awareness of handover systems, team working and harbouring of professional responsibility (Gordon 2011). It is unclear to what extent handover is currently being addressed in undergraduate medical education.

Recently, we carried out a qualitative study to determine current teaching and assessment methods, as well as attitudes towards handover within UK medical schools. Sixteen (50%) schools took part in the study. All schools reported ward-based exposure to handover, although no other education took place in 44% of schools. Thematic analysis of free text responses yielded a number of key themes. There was universal agreement that Handover is an important education issue. There was also agreement that limitations in handover research are delaying teaching innovations and there was recognition of a lack of validated assessment tools. There was disagreement on when such education should occur. Some respondents felt it should indeed be embedded in the undergraduate curricula, recognising the multi-faceted complexity of handover as a skill and its importance as a patient safety issue. Conversely, the majority of respondents felt that handover should be taught when ‘relevant to trainees’ within postgraduate training.

Whilst the majority of schools felt that handover is a skill to be learnt ‘on the job’ in postgraduate training, this author feel that this is a flawed viewpoint. Handover cannot be viewed as a distinct free standing skill. Effective handover is built on a portfolio of generic professional skills and this skill set is acquired from the very start of undergraduate training. Considering the previously discussed theoretically grounded model, a systems approach to improving handover may indeed be appropriate to address in the postgraduate setting. However, the issues of professional responsibility and team-working are key areas that can and should be addressed in undergraduate training. The use of observation as a sole method of tuition is at odds with these theoretically sound elements of handover education.

A consensus must be reached on the extent of handover education in undergraduate medical training. Future research is also needed to describe and assess the efficacy of teaching and assessment innovations. This will offer guidance to medical educators hoping to incorporate training on this key patient safety issue.

Morris Gordon, Faculty of Health and Social Care, University of Salford, Salford, UK. Department of Paediatric Gastroenterology, Royal Manchester Children's Hospital, Manchester, UK. Mary Seacole Building, MS 3.48, Frederick Road Campus, University of Salford, Greater Manchester, M6 6PU, UK. E-mail: [email protected]