AMA Wire

Wednesday, July 24, 2013

For Residents

Improved handoffs the aim of new sign-out protocol

All residency programs must teach competency in patient handoffs, as mandated by the Accreditation Council for Graduate Medical Education Common Program Requirements, particularly as duty hours reforms have multiplied the number of handoffs in which residents participate.

Despite these requirements, many physicians have said that tools to facilitate education on patient handoffs are lacking. Allison S. DeKosky, MD, and colleagues are seeking to help fill that gap with a new protocol published in the Journal of Graduate Medical Education. The mnemonic, called the “UPDATED Approach,” emphasizes the importance of seven attributes of sign-outs:

  • Updated administrative data
  • Prioritized problem list
  • Diagnoses in the one-liner
  • Anticipated problems clear
  • Too much information
  • Error-prone medication highlighted
  • Directions that are clear

The authors also stress that residents should be taught that peer assessment, self-assessment and maintenance of high-quality sign-outs are professional obligations.

The AMA offers a patient handoffs resource Web page featuring this and other handoff techniques to help residents improve patient care.

How states are addressing the physician shortage

Many parts of the country are beginning to feel the impact of the impending physician shortage. How each state is addressing that shortage, however, is very different.

The Wall Street Journal recently chronicled some of these strategies from across the country. For example, Florida added an additional 700 residency slots, while California is expanding the scope of practice for nurse practitioners, optometrists and pharmacists. States such as South Dakota are creating loan repayment incentives to entice residents and medical students to stay in underserved areas.

On the federal level, the AMA is urging Congress to retain Medicare support and federal funding for graduate medical education (GME) to protect access to care and address physician shortages in undersupplied specialties and locations.

Visit the AMA’s grassroots advocacy site,, to be part of the concerted effort to protect federal funding for GME.