Medical Science Educator

, Volume 28, Issue 2, pp 345–350 | Cite as

Implementation of a Peer-to-Peer Teaching Intervention Improved Electronic Discharge Summary Documentation by New Internal Medicine Residents

  • Ahmed Otokiti
  • Paulisa Ward
  • Merina Dongol
  • Abdelhaleem Sideeg
  • Mohamed Osman
  • Syed Abid
  • Oloruntobi Rahaman
  • Latif Rafay
  • Raji Ayinla
Original Research



The early months of residency training (EMCT) from July to September can be overwhelming for interns, or post-graduate year one (PGY1) residents. Traditional orientation may not be sufficient to ensure a smooth transition to residency. Interns are responsible for completing discharge summaries in most training hospitals but receive little or no prior training. The objective of this study was to determine the effectiveness of a peer-to-peer orientation of new (incoming) PGY1 internal medicine residents by present (outgoing) PGY1 residents.


This was an observational, analytical (cohort), single-center study. The intervention group, new (incoming) 2016 internal medicine, or PGY1, residents were exposed to a 2-h peer-to-peer orientation, in addition to the traditional orientation process. The internal medicine residents from the previous year (2015 PGY1 residents), exposed to only the traditional orientation process (TOP) prior to their commencement of residency, served as the control group. A comparison between the groups’ discharge summary documentation (DC summary) was performed using an independent two-sample t test; linear regression analysis was applied to control for potential confounders.


Statistically significant differences were found in mean discharge summary scores between the intervention and control group. The intervention group had a higher average score (mean 73.6; standard deviation (SD) 12.3; 95% confidence interval (CI) 68.0–79.1) than the control group (mean 65.7; SD 7.9; 95% CI 62.5–69.0). Using a two-tailed independent t test, the mean difference between both groups was found to be 7.8, or 12% (95% CI 1.8–13.8; p = 0.012).


This highly portable intervention may improve discharge summary documentations by new PGY1 residents during EMCT if implemented nationwide.


Medical education Electronic discharge summary Clinical documentation Internal medicine residents 


Compliance with Ethical Standards

The need for “special research informed consent” was waived by IRB, and departmental approval for quality improvement project was obtained as per our hospital policy. Voluntary completion of a pre-intervention basic demographic survey served as consent to participate in the intervention.

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. 1.
    Young JQ, Ranji SR, Wachter RM, Lee CM, Niehaus B, Auerbach AD. “July effect”: impact of the academic year-end changeover on patient outcomes: a systematic review. Ann Intern Med. 2011;155(5):309–15. Scholar
  2. 2.
    Wright M, Mankey CG, Miller BW. Improving upon the ‘July effect’: a collaborative, interdisciplinary orientation for internal medicine interns. Med Educ. 2013;18(1):23249. Scholar
  3. 3.
    Axon RN, Penney FT, Kyle TR, Zapka J, Marsden J, Zhao Y, et al. A hospital discharge summary quality improvement program featuring individual and team-based feedback and academic detailing. Am J Med Sci. 2014;347(6):472–7. Scholar
  4. 4.
    Singh G, Harvey R, Dyne A, Said A, Scott I. Hospital discharge summary scorecard: a quality improvement tool used in a tertiary hospital general medicine service. Intern Med J. 2015;45(12):1302–5. Scholar
  5. 5.
    Momin SR, Lorenz RR, Lamarre ED. Effect of a documentation improvement program for an academic otolaryngology practice. JAMA otolaryngology—head & neck surgery. 2016;142(6):533–7. Scholar
  6. 6.
    Rohr R. Engaging physicians in clear documentation: a pathway to value. Physician leadership journal. 2015;2(6):60–2.Google Scholar
  7. 7.
    Chow KM, Szeto CC, Chan MH, Lui SF. Near-miss errors in laboratory blood test requests by interns. QJM. 2005;98(10):753–6. Scholar
  8. 8.
    Barry WA, Rosenthal GE. Is there a July phenomenon? The effect of July admission on intensive care mortality and length of stay in teaching hospitals. J Gen Intern Med. 2003;18(8):639–45. Scholar
  9. 9.
    Rich EC, Gifford G, Luxenberg M, Dowd B. The relationship of house staff experience to the cost and quality of inpatient care. JAMA : the journal of the American Medical Association. 1990;263(7):953–7. Scholar
  10. 10.
    Rich EC, Hillson SD, Dowd B, Morris N. Specialty differences in the ‘July Phenomenon’ for Twin Cities teaching hospitals. Med Care. 1993;31(1):73–83. Scholar
  11. 11.
    Englesbe MJ, Pelletier SJ, Magee JC, Gauger P, Schifftner T, Henderson WG, et al. Seasonal variation in surgical outcomes as measured by the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP). Ann Surg. 2007;246(3):456–62; discussion 63-5. Scholar
  12. 12.
    Jen MH, Bottle A, Majeed A, Bell D, Aylin P. Early in-hospital mortality following trainee doctors’ first day at work. PLoS One. 2009;4(9):e7103. Scholar
  13. 13.
    Barro J, Huckman R, Song H. Cohort turnover and productivity:the July phenomenon in teaching hospitals. 2005. [cited 2016 December, 27]; Available from:
  14. 14.
    Singer BD, Corbridge TC, Schroedl CJ, Wilcox JE, Cohen ER, McGaghie WC, et al. First-year residents outperform third-year residents after simulation-based education in critical care medicine. Simul Healthc. 2013;8(2):67–71. Scholar
  15. 15.
    Szmuilowicz E, Neely KJ, Sharma RK, Cohen ER, McGaghie WC, Wayne DB. Improving residents’ code status discussion skills: a randomized trial. J Palliat Med. 2012;15(7):768–74. Scholar
  16. 16.
    Stefan MS, Belforti RK, Langlois G, Rothberg MB. A simulation-based program to train medical residents to lead and perform advanced cardiovascular life support. Hosp Pract (1995). 2011;39(4):63–9.CrossRefGoogle Scholar
  17. 17.
    Smith CA, Hart AS, Sadowski LS, Riddle J, Evans AT, Clarke PM, et al. Teaching cardiac examination skills. A controlled trial of two methods. J Gen Intern Med. 2006;21(1):7–12. Scholar
  18. 18.
    NQF. Endorsement summary: care coordination measures. Washington, DC: National Quality Forum; 2012. [cited 2017 August, 6]; Available from: Google Scholar
  19. 19.
    Louden K. Creating a better discharge summary. American College of Physicians; 2009. [cited 2016 April, 23]; Available from:
  20. 20.
    Kind AJH, Smith MA. Documentation of mandated discharge summary components in transitions from acute to subacute care. In: Henriksen K, Battles JB, Keyes MA, Grady ML, editors. Advances in patient safety: new directions and alternative approaches, vol. 2. Rockville: Culture and Redesign; 2008.Google Scholar
  21. 21.
    Steinert Y, Snell L. Interactive lecturing: strategies for increasing participation in large group presentations. Med Teach. 1999;21(1):37–42.CrossRefGoogle Scholar
  22. 22.
    van Walraven C, Rokosh E. What is necessary for high-quality discharge summaries? Am J Med Qual. 1999;14(4):160–9. Scholar
  23. 23.
    Hulley SB. Designing clinical research: Wolters Kluwer health/Lippincott Williams & Wilkins; 2007.Google Scholar
  24. 24.
    Brezis M, Cohen R. Interactive learning in medicine: Socrates in electronic clothes. QJM : monthly journal of the Association of Physicians. 2004;97(1):47–51. Scholar

Copyright information

© International Association of Medical Science Educators 2018

Authors and Affiliations

  1. 1.Internal Medicine DepartmentHarlem Hospital CenterNew YorkUSA
  2. 2.College of Physicians and SurgeonsColumbia UniversityNew YorkUSA

Personalised recommendations