Discharge as a supervised management moment: the SAFE-DC communication tool

Hospital discharge is a complex and error-prone process for internal medicine patients, which requires making nuanced management decisions, collaborating with multiple stakeholders, integrating patient preferences, and addressing structural barriers to care. To date, educational innovations targeting the discharge process have focused on interprofessional collaboration, patient communication, written discharge summaries, and competency-based assessment tools. The authors argue that formulating and communicating a discharge plan is a critical "management moment" for trainees and that providing supervision and feedback on this process is an important responsibility for inpatient attending physicians. A critical gap in hospital discharge education is discharge plan formulation-a key competency that is undertaught and variably supervised for internal medicine trainees. To address this gap, in 2025, the authors developed the SAFE-DC (Summary, Active Issues, Follow-Up, Exit, Drugs and Devices, Counseling) communication tool, which is designed for attending physicians to implement as an oral presentation format that guides internal medicine trainees in formulating and communicating discharge plans during attending rounds. Attendings can use the tool to supervise trainee management reasoning, ensure completion of all necessary discharge tasks, and provide structured, real-time feedback to trainees on their discharge management plans. In this Scholarly Perspective, we describe the SAFE-DC communication tool, illustrate its implementation and use on internal medicine teams, and share key lessons learned for clinician educators.