Patient Handover as a Learning Activity for Medical Students

The move of medical education in North America to a model based on teaching competencies rather than knowledge requires new methods of assessment. As part of a longer-term project to create objective and quantifiable measures for the learning of these competencies, we argue that the focus should be on the Entrustable Professional Activities (EPAs) that are associated with each competency. In this paper we present a theoretical constructivist analysis of one such EPA, that of patient handover, which is critical to patient safety. By applying an Activity Theory analysis to this EPA, we were able to identify, and thus quantify, key components of the EPA. Analysis of student performance on an online virtual patient simulation of a trauma case indicated that surgical clerkship students were able to correctly mention the majority of the procedures that expert surgeons indicated were most important, but only used less than a third of the professional terms that experts thought appropriate. This result points to a need to increase direct instruction in professional communication among medical learners, while demonstrating that Activity Theory provides an analysis that not only captures what is happening in the learning, but also can be used to develop objective and quantifiable assessment metrics.