Teaching a skill

Why it is built this way

Clinical handover has a mnemonic, several in fact: ISBAR, ISOBAR, SBAR, SHARED. A student can learn any of them in a minute and still fumble the first real one, because handover is not a fact to be recalled. It is a performance given to a colleague who is tired, in a hurry, and about to take responsibility for a person on the strength of what they are told.

So the session spends fifteen minutes on the mnemonic and the remaining hundred and five on doing it. Every student hands over at the bedside about a patient they have actually cared for that week. Every student then sits on the other side of it and receives one, which is the half people are rarely taught and the half that teaches them what a bad handover feels like. They swap patients before the second round, so nobody reviews the same case twice.

The peer feedback is scripted. Not because students cannot think of questions, but because "that was good" is what they will say if you let them, and it teaches nobody anything.

The last half hour turns the spoken handover into a written one. Same information, different discipline, and the point at which most students discover that what they said out loud was thinner than they thought.

What students should be able to do

  • Use frameworks such as body systems, head-to-toe, activities of daily living and functional health assessment to collect data sufficient for a complete clinical handover
  • Structure a handover and deliver it to colleagues, both to a partner and to a group
  • Engage colleagues and the facilitator in discussion about information that is missing, erroneous or not understood in the verbal handover
  • Decide on appropriate documentation of care, both the physical observations and the broader handover
  • Take part in peer review of documentation for accuracy and completeness of data

The two hours

  1. 5 min

    Introduce the session and review the learning objectives.

  2. 15 min

    Revise handover structures from the earlier session: ISBAR, ISOBAR, SBAR, SHARED, HAND ME AN ISOBAR. Revise assessment frameworks: body systems, head-to-toe, activities of daily living, functional health assessment.

    This is the only block that looks like teaching. It is an eighth of the session.

  3. 20 min

    At the bedside, the first student hands over to a peer using one of those structures, drawing on the care they have given during the week.

    The emphasis is on assessment: you cannot hand over what you never went looking for.

  4. 15 min

    Structured peer review, on four questions:

    • What was good about the handover you just received, and what would you ask your peer to keep doing?
    • What was missing from it, and what specific strategies would address that?
    • How was the handover delivered?
    • How could the delivery be improved?

    Content and delivery are reviewed separately, because they fail separately.

  5. 20 min

    Students change patients, so nobody reviews the same case twice. The second student hands over.

  6. 15 min

    Structured peer review again, same four questions, this time asking for specific strategies on delivery as well as content.

  7. 30 min

    Students individually write progress notes for a patient. Discuss documentation by exception, and complete documentation in relation to legal compliance. Each student reports on what they learnt from their colleagues and from the session.

15 minutes being told, 105 minutes doing it.

Created by Naomi Malouf for Charles Darwin University. NUR343 Simulation Block, 2017.

The other two problems, and the films made for them. How do we learn?