153: Resident Attitudes and Adherence to I-PASS: A Qualitative Study
Bibliographic record
Abstract
The main I-PASS Study assesses the effectiveness of a Handoff Bundle (team training, verbal mnemonic, and electronic written handoff tool) at nine residency programs using quantitative data on patient safety outcomes as well as efficiency and provider satisfaction. The objective of this ancillary qualitative study was to describe in detail the resident experience of I-PASS implementation, in general and with respect to the individual components, in order to inform future refinements and implementation strategies. Focus groups with residents (n=54); and semi-structured interviews with faculty (n=28) and other personnel (n=10) were conducted at eight of nine I-PASS sites. A structured codebook was developed to facilitate descriptive coding of transcripts, and data were synthesized and summarized using content analysis. Triangulation was employed by comparing findings across data sources. Residents generally accept I-PASS to be a ‘gold standard’ form of handoff and value learning a structured approach. Junior residents and some senior residents feel more secure using a structured format and most recognize that the program enhances handoff quality and patient safety. Efficiency was the most common factor cited when residents expressed concern about I-PASS. They regard it as neither necessary nor feasible to follow I-PASS for every patient and situation. Across all sites, residents report adhering to I-PASS when observed, but adhering selectively in usual practice. Residents were more likely to adhere with complex patients, unfamiliar teams, and evening vs. morning handoff. They also report using elements of the I-PASS mnemonic variably, with “synthesis by receiver” rarely used outside the context of observation. Anything perceived to lengthen handoff was unwelcome. Most residents value the computerized written handoff tool, but at sites with significant tool usability problems, dissatisfaction extended to the whole I-PASS program. The degree to which resident feedback was sought and acted upon moderated this. Perceptions of the faculty role varied. Residents generally understood that faculty have different handoff needs and practices, so did not perceive faculty as hypocritical if they did not adhere to I-PASS themselves. The experiences of observation and feedback were mixed. Residents reported variation in faculty feedback styles; some residents found it constructive while others found it ‘nitpicky’. Residents felt that the I-PASS program improved safety, but had concerns about efficiency. Optimizing computerized handoff tools, efficiency of verbal handoffs, and feedback to residents will be important in future refinements and implementation efforts.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.017 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.004 | 0.003 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".