Since the publication of seminal papers on patient safety and quality such as To Err is Human and Crossing the Quality Chasm, improving deliverance of healthcare and training new physicians in such best practices has been a focus of the Accreditation Council for Graduate Medical Education (ACGME).1,2 Modern patient care is complex and in the era of work hour limitations, numerous TC present an opportunity to potentially put a patient at risk. As the US healthcare system continues to evolve at a rapid pace, the care of any given patient is often provided by a variety of healthcare providers across multiple different clinical environments. From the literal routine in how handoff is performed to the physical space in which it occurs, ample occasions for distraction and decreases in communication and understanding exist. Patient safety may be enhanced or reduced at these critical junctures of “signing out.”

Residents and fellows are key players in these handoffs of care. The majority of GME-lead efforts and training paradigms are rightfully focused on training young physicians in the technical and cerebral skills and knowledge inherent to their specialty. What has become increasingly important over the last several years is that specific training should be focused on optimizing transitions of care to maximize quality and safety of patients.

This is especially true for surgical trainees, where operative and technical considerations related to the patient's condition add a level of complexity that may not be as readily appreciated by nonsurgical care providers. In addition, specific oral communication skills have always been an important component of surgical training. From traditions in surgery such as oral board exams and delivering presentations at morbidity and mortality conferences, surgical residents are taught early on that words matter. Similar to becoming proficient in the particular steps of performing an appendectomy, or any other given procedure, so too should “giving good sign-out” be seen as a skill that can be taught, learned, and improved upon. Best practices that are commonly cited for effective and efficient handoff include: “to-do” lists, use of “if-then” statements, ample opportunity and expectation for the receiver of sign-out to ask questions, and “read-backs” of crucial information at the conclusion of handoff. Formal time for simulation events offers the opportunity for resident and fellow practice as well as faculty engagement and assessment of learner skills.3

We aimed to study across multiple institutions how ACS services, which often utilize various handoff strategies given their large teams with various types of healthcare providers, perform signout. Our goal was to investigate how these processes take place, how they are viewed by postgraduate surgical trainees (PGY-1-PGY-7), and what aspects could be identified as best practices for further development in surgical education. To our knowledge this is the first multicenter study that aims to evaluate TC on ACS services.