Faculty supervision of the house staff handoff process: the time has come.

t q t b v m m a o t c m m p b The Accreditation Council for Graduate Medical Education is taking bold new initiatives to make residency education more accountable to the public. If this is not done by the Accreditation Council for Graduate Medical Education, it will surely be legislated by governmental agencies that are paying the bill for Graduate Medical Education training, which would include requirements for more direct observation of a trainee’s performance, documentation of the trainee’s individual clinical outcomes, and educational outcomes of the residency training program. The creation of “the milestones” makes it easier to document specific behaviors and performance on specific tasks. Previously, some of our faculty ratings were a result of supervisory “gestalt” rather than direct observation of the task by the trainee/learner. Direct observation is the only way to discern the difference between what the learner “can do” versus what the learner “actually does.” This has been well described in faculty development sessions at our institution with Dr Eric Holmboe of the American Board of Internal Medicine, as well as by Dr Louis Pangaro at the Clerkship Directors of Internal Medicine meeting in October, 2005. The fact that a learner has the knowledge, skills, and attitude of a particular task does not mean this automatically translates into desired behaviors at the bedside, thus the need for more direct supervision and direct observation in all of our training programs. This is the essence of competency-based education. This direct observation will be applied to the Entrustable Patient Activities. No Entrustable Patient Activity is more important than the process of “handoffs.” No Entrustable Patient Activity requires more direct observation and supervision than the handoff process if we are to increase the patient safety culture and environments in our teaching hospitals. The process of handoffs has been studied for some time. As a consequence of the mandated changes in house taff duty hours, we have an average of 5.2 handoffs per day per patient in the United States. This number is chilling in the mathematic calculation of risk for each patient in the