Highlight
- A structured discharge curriculum for fourth-year medical students markedly enhances their knowledge and skills related to patient discharges.
- 75% of students independently performed all discharge-related tasks following curriculum completion as observed in workplace-based assessments.
- Direct observation scores of student discharge skills strongly predict improved patient-reported understanding of urgent or emergent situation management.
- Student-initiated follow-up phone calls to patients serve as a key motivating factor in refining discharge communication skills.
Study Background
Hospital discharge is a critical transition point in patient care, often fraught with risks such as misunderstandings about medication regimens, follow-up appointments, and symptom management. Inadequate patient comprehension at discharge contributes substantially to readmissions and adverse post-discharge events. Despite this known risk, medical education frequently lacks structured training to equip students with the necessary skills to deliver effective discharge instructions.
The integration of a dedicated discharge curriculum in undergraduate medical training is essential to address these gaps. Training medical students during their sub-internship in providing clear, actionable discharge instructions aligns with patient safety goals and fosters better health outcomes after hospitalization.
Study Design
This mixed-methods study involved fourth-year medical students enrolled in an internal medicine sub-internship. The intervention comprised a multifaceted patient discharge curriculum consisting of four components:
- Self-study of instructional materials covering discharge planning and communication strategies.
- Direct supervised observation of students delivering discharge instructions to patients, paired with immediate feedback.
- A follow-up phone call initiated by the student to the patient post-discharge, reinforcing instructions and addressing questions.
- Participation in a small group debriefing session to reflect on experiences and share insights.
Outcomes were measured through pre- and post-curriculum surveys assessing knowledge and self-reported skills, as well as standardized workplace-based assessments. Logistic regression analysis was employed to evaluate the relationship between direct observation scores and patient-reported outcomes.
Key Findings
Completion of the structured discharge curriculum resulted in statistically significant improvement in all measured domains of knowledge and self-assessed skills related to patient discharge (p < 0.001). Observational assessments demonstrated that 75% of students performed all discharge tasks independently, indicating a high level of competency acquisition.
Importantly, direct observations of student performance were significantly associated with patient-reported understanding of how to act in urgent or emergent situations (Odds Ratio [OR] = 29.52, p = 0.002). This finding underscores the direct impact of student competence on patient safety and care quality post-discharge.
Students reported that conducting post-discharge phone calls was particularly motivating, driving them to communicate more carefully and thoroughly during the initial discharge encounter.
Expert Commentary
Effective discharge communication has been repeatedly linked to reductions in readmissions and improved patient satisfaction. While attending physicians often carry the responsibility for discharge instructions, empowering medical students through structured curricula may expand this educational focus early in clinical training.
This study’s strengths include its mixed-methods approach and direct linkage to patient-reported outcomes, providing valuable insight into the translational impact of educational interventions. However, limitations include the single-center setting and reliance on self-reported measures, which may affect generalizability.
Future research should explore longitudinal effects of discharge training on practicing physicians and integration into interprofessional education frameworks.
Conclusion
The implementation of a structured discharge curriculum during the internal medicine sub-internship substantively improves medical students’ proficiency in delivering discharge instructions and is associated with enhanced patient understanding of critical post-discharge care. These findings advocate for formal incorporation of targeted discharge education to promote safer transitions from hospital to home, ultimately improving clinical outcomes.
Funding and ClinicalTrials.gov
No funding sources or clinical trial registration information were reported for this study.
References
1. Kripalani S, Jackson AT, Schnipper JL, Coleman EA. Promoting effective transitions of care at hospital discharge: a review of key issues for hospitalists. J Hosp Med. 2007 Sep;2(5):314-23.
2. Hansen LO, Young RS, Hinami K, Leung A, Williams MV. Interventions to reduce 30-day rehospitalization: a systematic review. Ann Intern Med. 2011 Oct 18;155(8):520-8.
3. Sreedhar R, Yudkowsky R, Khan A, et al. Aligning Patient Discharge Curricula to Patient-Reported Outcomes in Sub Internship. J Gen Intern Med. 2026 May;41(10):2772-2778. PMID: 42115572.
