Shift-to-shift handoffs refer to the process of transferring role and responsibility for providing care from one person to another, thus insuring continuity of care. Through focus groups of residents and supervising physicians, we studied how physicians select patient cases to discuss during handoffs. We also compared the selection across level of experience. Understanding the patient selection criteria can give us insight into how to improve handoffs, in particular using supportive technologies that are integrated into the clinical information system. Studying the actual handoff process and note-taking also generated suggestions for handoff improvement.