A novel curriculum to train physician assistant students how to write effective discharge summaries

Figures & data

Figure 1. Students were asked to complete this pre-survey prior to independently authoring a discharge summary. They completed a similar post-survey after completion of the curriculum.

Figure 2. Evaluators rated submitted discharge summaries using this standardized template.

Figure 3. Demonstrates rates of student participation in discharge summary curriculum. Of 88 eligible students, 84 participated either via the review and reflect pathway (n = 21) or writing de novo discharge summaries (n = 63). All participating students received faculty advisor feedback. Of the 63 students who wrote de novo discharge summaries, 50 received additional feedback from inpatient providers (IPPs).

Table 1. Comparison of IPPs’ and advisors’ evaluations of new discharge summaries written by students.

Rating instrument	IPP	Advisor	Either
Overall quality, Mean (SD)	8.52 (1.09)	7.90 (1.43)*
Percent entrustable by EPA, N (%)**	46 (92.00%)	46 (93.88%)
Missing rates of key elements, N (%)
Primary diagnoses	0 (0%)	0 (0%)	0 (0%)
History of present illness	1 (2%)	0 (0%)	1 (2%)
Past medical history	2 (4%)	5 (10%)	7 (14%)
Physical exam at discharge	2 (4%)	1 (2%)	3 (6%)
Hospital course	0 (0%)	0 (0%)	0 (0%)
Pending lab results	2 (4%)	0 (0%)	2 (4%)
Outpatient follow-up tests	3 (6%)	1 (2%)	4 (8%)
Discharge medications	0 (0%)	0 (0%)	0 (0%)
Follow-up appointment	1 (2%)	5 (10%)	6 (12%)
Discharge destination	2 (4%)	6 (12%)	7 (14%)
Home health needs	3 (6%)	9 (18%)	12 (24%)
Functional/mobility status	4 (8%)	7 (14%)	10 (20%)
Goal of care/code status	4 (8%)	6 (12%)	7 (14%)

The top portion of the table indicates how de novo discharge summaries were rated on an overall global scale (1–10, with 10 being perfect) and the number of students rated as entrustable to receive patient care handoff by inpatient providers (IPPs) and faculty advisors. The bottom portion of the table indicates whether key elements were rated as missing by IPPs and advisors. There was poor concordance among evaluators, so the third column indicates if an element was rated as missing by either evaluator. An item is listed as present if it was listed in the discharge summary or appropriately listed as ‘not applicable’ (e.g., explicitly indicated no follow-up tests are needed would count as ‘present’ under the item outpatient follow-up tests). *Global rating scales were significantly higher by IPPs than faculty advisors (p = 0.006). **There were 50 IPP entrustability ratings from IPPs and 49 entrustability ratings from faculty advisors, with one missing faculty advisor response.

Figure 4. Demonstrates student responses (N = 54) to four matched statements on the pre- and post-surveys. *Combining agree/strongly agree and disagree/strongly disagree into two groups, students demonstrated significant improvement on knowledge of key elements (p < 0.001), comfort in writing a discharge summary (p < 0.001), and confidence that their discharge summaries could effectively be used to transition care (p = 0.011).