Ivan Zvonar, Max Griffith, Alexander Garrett, Bjorn Watsjold, Laura Welsh, Allison Beaulieu, Jonathan S Ilgen, Joshua Jauregui
Residents ritualize handoff as part of their learning during training, resulting in outcomes separate from the information transfer that has traditionally been studied. Reframing handoff as a form of ritualized behavior has implications for how group processes are implemented within training environments, and provides fertile ground to rethink other practices in medical education that face similar barriers to change.
PURPOSE: The transition of patient care responsibility-known as handoff-is a critical moment of information transfer for ensuring appropriate care and patient safety. Often occurring in group settings during residency due to the presence of multiple trainees, it is an essential skill for physicians to develop. Structured approaches to handoff have been developed and are considered best practice, yet implementation remains a challenge. The aim of this study was therefore to examine resident experiences with group handoff. In particular, as handoff is a shared experience, the authors sought to illuminate its underlying social aspects in hopes of elucidating implicit parts of the process that may impact resident education and structured handoff implementation.
METHOD: Residents from 2 emergency medicine residency programs were invited to participate in the study between August 2024-November 2025. Using constructivist grounded theory, the authors employed semi-structured interviews exploring participant experiences with group handoff. Through constant comparison, the authors identified the theoretical framework of ritual practice, and subsequently generated a theory regarding how residents engage with and experience group handoff.
RESULTS: The authors interviewed 14 residents from across the PGY spectrum. Residents noted group handoff as distinct from other routine clinical tasks. They described a ritualized practice that led to the evolution and reinforcement of underlying social structures. This was achieved by maintaining consistency throughout handoff, ensuring boundaries were respected, and engaging in choreography. Residents thereby integrated community, established norms, and cemented the hierarchy of those involved.
CONCLUSIONS: Residents ritualize handoff as part of their learning during training, resulting in outcomes separate from the information transfer that has traditionally been studied. Reframing handoff as a form of ritualized behavior has implications for how group processes are implemented within training environments, and provides fertile ground to rethink other practices in medical education that face similar barriers to change.