Narrative, written sign-outs and interns' and senior medical students' confidence: a randomized, controlled crossover...

Failures of communication during the transfer of patient care errors.

We created a new format for written sign-out material, based on aviation industry practice and cognitive psychology theory, designed to improve interns' and senior medical students' communication during transfers of patient care responsibility. We carried out a randomized, blinded, crossover trial, comparing a new, narrative, written sign-out report to a usual written sign-out. Thirty-two interns and fourth-year medical students rated their confidence across various clinical tasks and answered clinical questions regarding hypothetical patients presented to them in written, new, narrative sign-out compared with the customary format.

There was no statistical difference in confidence when interns and senior medical students received usual versus narrative sign-outs.

Although a limited measure suggested some improvement in competence, the narrative format did not improve participants' self-rated confidence during patient-care transfer.