Students' Critical Incidents Point the Way to Safer Patient Care Transitions

Patient care transitions are prevalent in health care, and faulty transition-related communications are associated with 80% of serious medical errors. While medical student curricula on care transitions are increasing, there are limited evaluation reports and little guidance on primary care transition training.

The Medical College of Wisconsin initiated an annual 2-hour patient care transition intersession for third-year medical students. The intersession used a critical incident report, where students wrote about a recent, de-identified patient transition they witnessed that evoked in them "a strong emotional reaction." Next, intersession training included a novel, structured communication handoff mnemonic. At the intersession conclusion, students wrote what they would do differently if their critical incident transition occured in the future. Evaluations (2010-2014) consisted of students' post-session reactions and learning. Authors completed a detailed, qualitative analysis of students' critical incident reports from the 2010 intersession.

Students reacted positively to all intersession elements, especially clinician-led, small-group discussions. Student reports revealed that over 90% of their critical incident evoked negative emotional reactions (eg, frustrated, disappointed, helpless). Post-intersession, 86% of students reported intentions to adopt new strategies to improve future care transitions, and 38% referenced components of the learned mnemonic.

Medical students reacted positively to this intersession, especially small-group discussions. Students revealed mostly negative emotions from their critical incident on patient handoffs, but they gained effective strategies for future handoff communications. Authors recommend continued use of the handoff mnemonic, with greater attention to training environments that emphasize patient and learner safety.