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Academic Medicine:
doi: 10.1097/ACM.0000000000000046
Research Reports

Teaching Medical Error Disclosure to Residents Using Patient-Centered Simulation Training

Sukalich, Sara MD; Elliott, John O. PhD, MPH; Ruffner, Gina EMT-P

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Abstract

Purpose: To determine whether a standardized patient encounter and self-guided tutorial would improve first-year residents’ self-efficacy for disclosing medical errors.

Method: In 2011, 55 first-year residents participated in a simulation in which they disclosed an error to a standardized patient playing the part of a family member. Residents completed the simulation twice, four weeks apart, and completed presession knowledge and self-efficacy (based on the Accreditation Council for Graduate Medical Education [ACGME] core competencies) assessments and repeated the self-efficacy assessment after the sessions. Residents reviewed the videos of their encounters either alone (self-debrief) or with a faculty observer (faculty debrief). Between sessions, they completed a self-paced learning tutorial. Two external faculty also rated the residents’ performances using videos of the encounters.

Results: Residents’ self-efficacy significantly increased from a Session 1 pretest mean (standard deviation) score of 119.6 (26.6) to a Session 2 posttest score of 150.3 (24.9) for all ACGME competencies (P < .001, Cohen's d = 1.19). The external reviewers’ ratings provided additional, objective support for residents’ improvement on questions assessing ACGME competencies (P = .001). Comparisons of the self-efficacy of residents in the self-debrief versus faculty debrief groups yielded no significant differences on any ACGME competencies.

Conclusions: Timely, explicit, and empathetic disclosure of medical errors to patients and family is essential to maintaining trust and is an important part of patient-centered medical care. This intervention easily could be replicated in other settings and is applicable to many members of the health care team, not just to residents.

© 2014 by the Association of American Medical Colleges

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