Using Ethnography to Capture Learner Experience in Handover Simulation Modules

BACKGROUND: Patient handovers, frequent, diverse, and integral parts of modern medical practice, involve the transfer of patient responsibility from one team of providers to another.1 This transition of care is often fragmented and has been shown to cause various adverse events, including patient injury, medication errors, and lengthened hospital stays.2-4 LOCAL PROBLEM: As simulation-based activities have increased in medical schools across the nation, an accompanying need to understand the learner experience has developed.5,6 UTSW has incorporated simulation-based learning with the Quality Enhancement Plan (QEP) to teach medical and health professions students team based communication. The aim of this study was to characterize learner attitudes toward simulation education during two simulation-based modules and to determine critical-to-quality elements of these courses through focused ethnography. METHODS: We describe a focused ethnographic study of two simulation-based modules of handover education using direct participant observation. The observers, medical students, and physician assistant student participant of these modules were asked to provide reflective summaries of their experiences during the simulation, including a description of what happened, attitudes about the experience, and reflections on potential improvement. Using qualitative analysis software, these ethnographic summaries were coded, and major themes were identified These themes were subsequently used to develop critical elements of the simulation activity in a Critical to Quality (CTQ) tree. RESULTS: Our analysis showed that the handover-simulation modules were regarded as generally both acceptable and appropriate. Coding of the ethnographic summaries clarified the major proponents of and deterrents to acceptability (Figure 2). Our analysis determined five components for a quality experience: organization, safety/security, engagement, reinforcement, and standardization. Out of the five critical to quality elements we identified, all five needs were described and confirmed in two concomitant focus group analyses of handover-simulation module participants, further validating an ethnographic approach in this context. CONCLUSION: Ethnographic research methods are an efficient and effective way to characterize learner attitudes and experiences in simulation education. Focused ethnography has identified several significant targets for improving the Safe Patient Handover simulation.