The Inconspicuous Learner Handover: An Exploratory Study of U.S. Emergency Medicine Program Directors’ Perceptions of Learner Handovers from Medical School to Residency

Abstract

Phenomenon: Central to competency-based medical education is the need for a seamless developmental continuum of training and practice. Trainees currently experience significant discontinuity in the transition from undergraduate (UME) to graduate medical education (GME). The learner handover is intended to smooth this transition, but little is known about how well this is working from the GME perspective. In an attempt to gather preliminary evidence, this study explores U.S. program directors (PDs) perspective of the learner handover from UME to GME. Approach: Using exploratory qualitative methodology, we conducted semi-structured interviews with 12 Emergency Medicine PDs within the U.S. from October to November, 2020. We asked participants to describe their current perception of the learner handover from UME to GME. Then we performed thematic analysis using an inductive approach. Findings: We identified two main themes: The inconspicuous learner handover and barrier to creating a successful UME to GME learner handover. PDs described the current state of the learner handover as “nonexistent,” yet acknowledged that information is transmitted from UME to GME. Participants also highlighted key challenges preventing a successful learner handover from UME to GME. These included: conflicting expectations, issues of trust and transparency, and a dearth of assessment data to actually hand over. Insights: PDs highlight the inconspicuous nature of learner handovers, suggesting that assessment information is not shared in the way it should be in the transition from UME to GME. Challenges with the learner handover demonstrate a lack of trust, transparency, and explicit communication between UME and GME. Our findings can inform how national organizations establish a unified approach to transmitting growth-oriented assessment data and formalize transparent learner handovers from UME to GME.

Keywords:

• Learner handover
• competency-based medical education
• educational continuum
• graduate medical education
• qualitative methods

Acknowledgments

The authors thank all of the emergency medicine residency program directors who volunteered to be interviewed as part of this study.

Disclosure statement

The authors have no conflicts of interest, financial or otherwise, to disclose.

Ethical approval

Ethical approval was obtained from the Institutional Review Boards at Stanford University School of Medicine (protocol 50089) and the University of Illinois at Chicago (protocol 2020-1333).

Additional information

Funding

This project received funding from the American Medical Association Reimagining Residency Grants Program as part of a planning grant.