Hand-off education and evaluation: Piloting the observed simulated hand-off experience (OSHE)

Jeanne M. Farnan, J. A M Paro, R. M. Rodriguez, S. T. Reddy, L. I. Horwitz, J. K. Johnson, V. M. Arora

Research output: Contribution to journalReview articlepeer-review

79 Scopus citations


Aim: The Observed Simulated Hand-off Experience (OSHE) was created to evaluate medical students' sign-out skills using a real-time assessment tool, the Hand-off CEX. Setting: Thirty-two 4th year medical students participated as part of an elective course. Program description: One week following an interactive workshop where students learned effective hand-off strategies, students participated in an experience in which they performed a hand-off of a mock patient using simulated history and physical examination data and a brief video. Program evaluation: Internal medicine residents served as standardized hand-off receivers and were trained on expectations. Students were provided feedback using a newly developed Hand-off CEX, based on the "Mini-CEX, " which rates overall hand-off performance and its components on a 9-point Likert-type scale. Outcomes included performance ratings and pre- and post-student self-assessments of hand-off preparedness. Data were analyzed using Wilcoxon signed-rank tests and descriptive statistics. Resident receivers rated overall student performance with a mean score of 6.75 (range 4-9, maximum 9). Statistically significant improvement was observed in self-perceived preparedness for performing an effective hand-off (67% post- vs. 27% pre-reporting 'well-prepared,' p < 0.009). Discussion: This brief, standardized hand-off training exercise improved students' confidence and was rated highly by trained observers. Future work focuses on formal validation of the Hand-off CEX instrument.

Original languageEnglish (US)
Pages (from-to)129-134
Number of pages6
JournalJournal of general internal medicine
Issue number2
StatePublished - Feb 2010


  • Hand-offs
  • Residency education
  • Simulation

ASJC Scopus subject areas

  • Internal Medicine


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