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Research Article
Ernie Esquivel
Weill Cornell Medical College
Corresponding Author
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: One in five patients suffer an adverse event within two weeks of discharge as they transition from one healthcare setting to another. Systems-based practice is a core competency of physicians and seeks to minimize these events; however, education of trainees is inconsistent. We asked whether structured post-discharge phone calls and reflections on barriers to discharge and practice improvement can enhance students’ understanding of systems-based practice.
Method: Medical students in the Internal Medicine Clerkship were assigned to perform a structured post-discharge phone call on hospitalized patients as part of a “Transitions of Care” assignment. Students reflected on issues occurring at the transition from hospitalization to discharge. We performed qualitative analysis of 90 medical student responses and identified themes and sub-themes addressing issues with care transitions.
Results: Students consistently identified barriers to safe discharge including issues scheduling follow-up care, poor care coordination, and inadequate social support. The post-discharge phone calls revealed problems with patients’ understanding of their discharge diagnosis, medication-related issues and patients’ failure to attend scheduled follow-up. Common student-proposed practice improvement interventions included: enhanced provider-patient communication and education, improved interdisciplinary collaboration and care coordination, and greater attention to patient’s psychosocial and financial status.
Conclusions: Medical students learned about systems-based practice from a transitions of care assignment involving a post-discharge phone call, identifying critical events in over half of patients identified. Self-reflective practice within the context of direct patient care offers insights into practice improvement in care transitions.
Keywords
systems-based practice, undergraduate medical education, care transitions, patient safety, reflective practice
No competing interests reported.
This is a list of supplementary files associated with this preprint. Click to download.
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CURRENT STATUS: Under Review
Version 1
Posted 29 Sep, 2021
No community comments so far
Reviews received
Received 13 Oct, 2021
Reviewers agreed
On 04 Oct, 2021
Reviewers invited
Invitations sent on 04 Oct, 2021
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On 04 Oct, 2021
Editor invited
On 28 Sep, 2021
Submission checks complete
On 28 Sep, 2021
First submitted
On 16 Jul, 2021
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This preprint is under consideration at BMC Medical Education. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
Ernie Esquivel
Weill Cornell Medical College
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 29 Sep, 2021
No community comments so far
Reviews received
Received 13 Oct, 2021
Reviewers agreed
On 04 Oct, 2021
Reviewers invited
Invitations sent on 04 Oct, 2021
Editor assigned
On 04 Oct, 2021
Editor invited
On 28 Sep, 2021
Submission checks complete
On 28 Sep, 2021
First submitted
On 16 Jul, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: One in five patients suffer an adverse event within two weeks of discharge as they transition from one healthcare setting to another. Systems-based practice is a core competency of physicians and seeks to minimize these events; however, education of trainees is inconsistent. We asked whether structured post-discharge phone calls and reflections on barriers to discharge and practice improvement can enhance students’ understanding of systems-based practice.
Method: Medical students in the Internal Medicine Clerkship were assigned to perform a structured post-discharge phone call on hospitalized patients as part of a “Transitions of Care” assignment. Students reflected on issues occurring at the transition from hospitalization to discharge. We performed qualitative analysis of 90 medical student responses and identified themes and sub-themes addressing issues with care transitions.
Results: Students consistently identified barriers to safe discharge including issues scheduling follow-up care, poor care coordination, and inadequate social support. The post-discharge phone calls revealed problems with patients’ understanding of their discharge diagnosis, medication-related issues and patients’ failure to attend scheduled follow-up. Common student-proposed practice improvement interventions included: enhanced provider-patient communication and education, improved interdisciplinary collaboration and care coordination, and greater attention to patient’s psychosocial and financial status.
Conclusions: Medical students learned about systems-based practice from a transitions of care assignment involving a post-discharge phone call, identifying critical events in over half of patients identified. Self-reflective practice within the context of direct patient care offers insights into practice improvement in care transitions.
No competing interests reported.
This is a list of supplementary files associated with this preprint. Click to download.
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