Table 1 Resident opinions on various components of handoff education, with illustrative quotes

Formal Curriculum

Though some residents found the lecture helpful, most residents were not significantly influenced by the lecture, either because they did not attend or because its contents were not memorable.

“At some point I think there was maybe like a lecture on this, in like grand rounds – not grand rounds, in like the resident lecture or something. But I’m not a hundred percent sure…it definitely did not stick. But I think I was there and I think it actually happened.” (CA3, M)

“It’s probably just too much. It goes right over a lot of our heads – I think, at least for me. I do remember her having the lecture and talking about some of those things, but it was just like – it was just – it was a lot.” (CA1, M)

Informal Curriculum

Training from attending physicians was inconsistent in both the extent to which handoffs were covered and the content that they taught.

“But again, people’s personalities are so different as far as how they teach residents here. I think people who take it seriously will always do a good job. And if we make it an emphasis of this program and if we put the emphasis on it as being safe like we’re doing with this work, I think interest in it will grow. But I don’t know that you can necessarily bring everyone around to this kind of thinking.” (CA2, M)

Handoff Locations

Overall, residents feel more far more comfortable doing PACU handoffs compared to SICU handoffs.

“I felt more prepared to do like a standard PACU handoff. Versus, yeah, the SICU, I wasn’t quite sure how to do that. And especially we were told that there was something on Epic that we could fill out, that critical care handoff sheet. And it’s like sometimes, we do that, sometimes we don’t do that. I’m not even sure where that information goes, if people can look at that. So yeah, I didn’t feel too prepared for the SICU.” (CA1, M)

Coordinating Handoff

Residents agreed that consistently having all the involved parties present and attentive would greatly aid their learning of the handoff procedure but was very difficult to achieve.

“Probably the first step, is building the awareness amongst all of the CTICU, the surgical ICU, and the neurosurgical ICU, the nursing staff and the physicians and the midlevel providers in those places, that this is part of what we’re trying to improve upon is handoffs. And so if you teach only the anesthesia residents, it’ll I think fall flat on its face, because the anesthesia residents will show up ready to give this five minute speech, that’s a completely comprehensive signout. And there’ll be no one there to listen to it. So I think sort of setting the stage for an effective handoff is probably more important as a first step than educating about a handoff.” (CA3, M)

Handoff Template

Though many residents thought a template would help them learn to give thorough handoffs, they disagreed on the extent to which it should be enforced.

“I’m not sure quite how you would deploy it, but I think that the general answer is to develop a standardized process and then expect it to actually occur.” (CA3, M)

“I think that after a while – I think [a template] might be helpful in the beginning, but after a while I think it could be – you don’t necessarily need it because you just get so use to everything that you need to hand off. But I think in the beginning it might be useful for the new CA1s coming in.” (CA1, F)

When to Teach

While some residents thought that handoffs should be taught during the one-to-one period, others felt that handoff education should occur later in the residency.

“I think that [handoffs] should be brought up during one-to-one time just because the – you have the time with an attending to actually do it and you’re usually there with another colleague. So they can definitely observe you.” (CA2, M)

“I think one-to-one time, you’re so overwhelmed with the basics and you’re terrified about pushing medications and keeping your patient alive, that absorbing that information, that is an absolute, that’s like probably the worst time to teach about handoffs.” (CA2, F)