Laura Lockwood
University of Colorado
Introduction: Inpatient teams often utilize cross-coverage – providing medical care to patients that are primarily cared for by another provider. Residents cross-cover from the start of internship, yet many begin without prior experience or confidence in cross-covering. The sub-internship is a ripe opportunity for cross-coverage experience in preparation for internship. The objectives of this study were to describe the implementation of a cross-cover curriculum rooted in experiential learning and explore the sub-intern cross-cover experience.
Methods: A cross-cover curriculum was created and piloted in accordance with Kern’s 6-step approach to curriculum development and grounded in Kolb’s cyclical model of experiential learning. Needs assessment involved a survey of sub-interns and additional feedback from educators and other stakeholders. The curriculum included a didactic session, asynchronous readings, experiential learning through cross-coverage, patient care logs, written reflections about experiences, and a small group reflection session. The curriculum was piloted across multiple inpatient sites with a convenience sample of pediatric sub-interns. Evaluation included sub-intern needs assessment data as a historical control (n=16), as well as a retrospective pre/post survey (n=15) analyzed via Chi-Square and Wilcoxon Signed-Rank tests, and content analysis of reflective writings.
Results: Fifteen sub-interns completed the curriculum. All sub-interns reported cross-covering on most or every call shift after curriculum implementation. The percentage of sub-interns who rated their ability to organize and prioritize responsibilities to provide safe, effective, and efficient care for cross-cover patients as more than moderately well significantly increased (13% vs 80%, p<0.0001). Qualitative themes from student writings included the importance of well-organized sign-outs, the challenges of cross-covering complex patients, and that unfamiliarity with cross-cover patients can be intimidating, yet the experience of cross-covering builds confidence.
Discussion: Learning about cross-coverage through “doing” (concrete experience) and subsequent reflection increased sub-intern cross-coverage and self-reported abilities. Written self-reflections demonstrated insight into benefits of clear sign-outs and provided examples of improving confidence by successfully dealing with issues. Additional work is needed to alleviate existing barriers to cross-coverage, and to objectively demonstrate the impact of a cross cover curriculum on learning, clinical performance, and patient care.
