Aligning Patient Discharge Curricula to Patient-Reported Outcomes in Sub Internship

BACKGROUND: Patients' lack of understanding of post-discharge treatment plans can result in readmissions and adverse events after discharge from the hospital. Despite this, there are few structured curricula for medical students to learn about safely discharging patients. OBJECTIVE: To determine the ability of a structured curriculum to improve medical students' knowledge and skills about discharge instructions. METHODS: Design and participants: This is a mixed-methods study involving fourth-year medical students in their internal medicine sub-internship. INTERVENTIONS: The patient discharge curriculum consisted of (a) self-study of patient discharge didactics, (b) direct observation and feedback of discharge instructions provided by students, (c) student-initiated post-discharge phone call to patients, and (d) a small group debrief activity. MAIN MEASURES: Skills were assessed using a standardized workplace-based direct observation of students providing discharge instructions. Changes in knowledge and skills were measured by differences in pre- and post-curriculum survey scores using a paired t test. Logistic regression was used to determine if the scores on direct observation could predict patient-reported outcomes. KEY RESULTS: All self-reported knowledge and skills outcomes related to patient discharges improved significantly after the curriculum (p < 0.001). The direct observation of students providing discharge instructions to patients after completing the curriculum revealed that 75% of students were able to independently perform all the discharge-related tasks. There was a significant association between scores on the direct observation of students and patient-reported knowledge of what to do in urgent or emergent situations (OR = 29.52, p = 0.002). Based on student feedback, follow-up phone calls to patients were a powerful motivator for them to improve discharge instructions. CONCLUSIONS: This study offers valuable evidence supporting the use of a structured discharge curriculum. This structured training in providing discharge instructions improves medical students' knowledge and skills about discharge instructions and positively impacts patient-reported outcomes.