Preparing Emergency Medicine Residents to Disclose Medical Error Using Standardized Patients.

Carmen Spalding,Sherri Rudinsky

doi:10.5811/westjem.2017.11.35309

Abstract

IntroductionEmergency Medicine (EM) is a unique clinical learning environment. The American College of Graduate Medical Education Clinical Learning Environment Review Pathways to Excellence calls for “hands-on training” of disclosure of medical error (DME) during residency. Training and practicing key elements of DME using standardized patients (SP) may enhance preparedness among EM residents in performing this crucial skill in a clinical setting.MethodsThis training was developed to improve resident preparedness in DME in the clinical setting. Objectives included the following: the residents will be able to define a medical error; discuss ethical and professional standards of DME; recognize common barriers to DME; describe key elements in effective DME to patients and families; and apply key elements during a SP encounter. The four-hour course included didactic and experiential learning methods, and was created collaboratively by core EM faculty and subject matter experts in conflict resolution and healthcare simulation. Educational media included lecture, video exemplars of DME communication with discussion, small group case-study discussion, and SP encounters. We administered a survey assessing for preparedness in DME pre-and post-training. A critical action checklist was administered to assess individual performance of key elements of DME during the evaluated SP case. A total of 15 postgraduate-year 1 and 2 EM residents completed the training.ResultsAfter the course, residents reported increased comfort with and preparedness in performing several key elements in DME. They were able to demonstrate these elements in a simulated setting using SP. Residents valued the training, rating the didactic, SP sessions, and overall educational experience very high.ConclusionExperiential learning using SP is effective in improving resident knowledge of and preparedness in performing medical error disclosure. This educational module can be adapted to other clinical learning environments through creation of specialty-specific scenarios.

Highlights

Emergency Medicine (EM) is a unique clinical learning environment
Experiential learning using standardized patients (SP) is effective in improving resident knowledge of and preparedness in performing medical error disclosure
This educational module can be adapted to other clinical learning environments through creation of specialty-specific scenarios. [West J Emerg Med. 2018;19(1)211–215.]

Summary

Introduction

Emergency Medicine (EM) is a unique clinical learning environment. The American College of Graduate Medical Education Clinical Learning Environment Review Pathways to Excellence calls for “hands-on training” of disclosure of medical error (DME) during residency. Emergency medicine (EM) is a high-risk clinical learning environment with reported rates of medical errors between 18% 1 to 32%.2 Unique challenges such as frequent interruptions, multiple transitions of care, time constraints, simultaneous management of multiple complex patients, decisions based on incomplete information, unfamiliar physician-patient relationship, and a lack of privacy increase the risk of medical errors and create barriers to effective identification and disclosure when errors occur.[3,4]. The 2010 American College of Emergency Physicians Policy Statement on Disclosure of Medical Errors 5 directs emergency physicians who determine an error has occurred to provide timely information about the error and its consequences to patients and their families. A survey of 55 EM residents from two programs demonstrated infrequent, inadequate disclosure to patients and families, occurring in only 28% of cases.[7]

Objectives

Methods

Conclusion