Education with a small ‘e’: Education within paediatric team handovers

Abstract

Paediatric team handovers involve medical professionals and students meeting regularly, and provide an opportunity for learning to occur. The research question was: To what extent do educational opportunities exist within paediatric team handovers in New Zealand secondary hospitals? Handovers between health professionals have become important processes to ensure the maintenance of patient safety. A literature review identified that education was perceived as an important function of handover, but the role of educational opportunities within handover had not been considered in detail. A qualitative, two-site case study was performed within two New Zealand paediatric departments. Semistructured interviews were undertaken, with purposive sampling of team members, including medical students, junior doctors and consultants. Twenty-nine participants were interviewed in 2014 and 2015, with subsequent transcription of the interviews. Thematic analysis using a general inductive approach was undertaken, and qualitative software was utilized. Data was coded iteratively, with identification of themes, which allowed detailed analysis and description of exemplar quotes. Informed consent was obtained from the Chief Executive Officers of both hospitals, the Heads of Department at the two sites, from the University of Auckland Human Participants Ethics Committee, and from each participant. The study confirmed that patient safety was a critical aspect of handover, and specifically that safe transfer of pertinent patient information between clinicians was crucial. Most learning opportunities were informal, and occurred as reactive learning opportunities or as implicit learning in the form of role modelling by consultants. Participants described a reflective approach to learning, in which they considered uncertainty within patient presentations, posed relevant questions and obtained feedback regarding performance. A shared mental model of the patient and their condition was co-constructed, and this process created learning opportunities. The handover team atmosphere was perceived as a potential barrier or enabler to learning occurring. The team could be viewed as a community of practice, and newcomers’ learning needs required particular consideration. Time pressures and clinical workload were significant limitations on the handover process, and represented potential barriers to education occurring within handover. Educational opportunities do exist within paediatric team handovers in New Zealand secondary hospitals. A focus on brief learning moments within handover, and adoption of a reflective approach to these opportunities is likely to result in improved educational experiences for handover participants. Keywords: Handover, handoff, clinical education, informal learning, workplace learning, patient safety, shared mental model, team, paediatrics, New Zealand.