Skills of Internal Medicine Residents in Disclosing Medical Errors: A Study Using Standardized Patients

Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Academic medicine: journal of the Association of American Medical Colleges (Impact Factor: 2.93). 12/2009; 84(12):1803-8. DOI: 10.1097/ACM.0b013e3181bf9fef
Source: PubMed


To determine internal medicine (IM) residents' ability to disclose a medical error using standardized patients (SPs) and to survey residents' experiences of disclosure.
In 2005, 42 second-year IM residents at the University of Toronto participated in the study. Each resident disclosed one medical error (insulin overdose) to an SP. The SP and a physician observer scored performance using a rating scale (1 = not performed, 2 = performed somewhat, and 3 = performed well) that measures error disclosure on five specific component skills and that provides an overall assessment score (scored on a five-point scale, 5 = high). Residents also completed a questionnaire.
The mean scores on the five components were explanation of medical facts (2.60), honesty (2.31), empathy (2.47), future error prevention (1.99), and general communication skills (2.47). The residents' mean overall disclosure score was 3.53. Although 27 of 42 residents (64%) reported previous experience in disclosing an error to a patient during their training, only 7 (27%) of these residents reported receiving any feedback about their performance. Of 41 residents, 21 (51%) had received some prior training in disclosure, and 38 (93%) thought additional training would be useful and relevant.
Disclosing medical error is now a standard practice. Experience with medical error begins early in training, and preparing trainees to discuss these errors is essential. Areas exist for improvement in residents' disclosure abilities, particularly regarding the prevention of future errors. Curricula to increase residents' skills and comfort in disclosure need to be implemented. Most residents would welcome further training.

7 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Medical errors occur frequently in routine health care. Historically, many of these errors were not disclosed to patients but increasingly there are calls for frank and open disclosure of errors to patients and families. This article provides an overview of what information should be disclosed about errors, what patients want to be told, the attitudes and skills of physicians in disclosure, and the barriers to effective disclosure. This article also includes a description of the changing policy environment in North America that is encouraging and mandating disclosure of errors.
    Patient Education and Counseling 09/2009; 76(3):296-9. DOI:10.1016/j.pec.2009.07.018 · 2.20 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The emotional toll of medical error is high for both patients and clinicians, who are often unsure with whom-and whether-they can discuss what happened. Although institutions are increasingly adopting full disclosure policies, trainees frequently do not disclose mistakes, and faculty physicians are underprepared to teach communication skills related to disclosure and apology. The authors developed an interactive educational program for trainees and faculty physicians that assesses experiences, attitudes, and perceptions about error, explores the human impact of error through filmed patient and family narratives, develops communication skills, and offers a strategy to facilitate bedside disclosures. Between spring 2007 and fall 2008, 154 trainees (medical students/residents) and 75 medical educators completed the program. Among learners surveyed, 62% of trainees and 88% of faculty physicians reported making medical mistakes. Of those, 62% and 78%, respectively, reported they did not apologize. While 65% of trainees said they would turn to senior doctors for assistance after an error, 26% were not sure where to get help. Just 20% of trainees and 21% of physicians reported adequate training to respond to error. Following the session, all of the faculty physicians surveyed indicated they felt better prepared to address and teach this topic. At a time of increased attention to disclosure, actual faculty and trainee practices suggest that role models, support systems, and education strategies are lacking. Trainees' widespread experience with error highlights the need for a disclosure curriculum early in medical education. Educational initiatives focusing on communication after harm should target teachers and students.
    Academic medicine: journal of the Association of American Medical Colleges 06/2010; 85(6):1010-7. DOI:10.1097/ACM.0b013e3181dbedd7 · 2.93 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Disclosing adverse events to patients after a poor outcome is an essential task involving both communication skills and professionalism, but one that is difficult to teach and assess during clinical rotations. Beyond ensuring clinical competency, these skills are essential in minimizing medico-legal risk. An objective structured clinical examination (OSCE) station with a standardized patient allows an opportunity to evaluate these skills. Our objective was to assess residents' communication skills involving the disclosure of a poor outcome to a standardized patient using a standardized patient encounter, and to compare their performance before and after formal teaching on disclosure. Fourteen obstetrics and gynaecology residents (PGY-2 to PGY-5) were evaluated in a two-station OSCE. In the first station, they obtained a history and counselled an obstetrical patient, and in the second station they met with the same patient to discuss an adverse outcome that had occurred. The residents were evaluated using guidelines for the disclosure of adverse events developed by the Canadian Patient Safety Institute and published by the Canadian Medical Protective Association. The residents then participated in a workshop on disclosure and were retested. The mean score in the pre-workshop disclosure OSCE was 59.1% (12.4/21, SD 2.7), while the mean score in the post-workshop OSCE was 80.1% (16.9/21, SD 2.1). Using the paired Student t test, the scores differed significantly with P < 0.01. Residents' performance in disclosure improves after formal teaching and the OSCE is an effective technique for testing communication skills.
    Journal of obstetrics and gynaecology Canada: JOGC = Journal d'obstetrique et gynecologie du Canada: JOGC 03/2011; 33(3):262-8.
Show more