Letters to the Editor
To the Editor:
In the June 2013 issue, Stroud and colleagues1 reviewed 21 studies of medical error disclosure curricula delivered to medical trainees by several teaching modalities that included primarily didactic lectures and occasional group activities. Despite the need to address medical error disclosure in the most effective possible manner, an alternative approach might be to try to prevent the initial error by giving learners the tools they need to develop skills and behaviors that lead to better patient outcomes. In order to capture the greatest number of learners, and thus prevent the greatest number of errors, it would be essential to employ teaching methods that address all learning styles. As such, we have found2 that by using androgogic principles to address all learning styles, a learner-centered curriculum can be effective in transmission of skill transfer and behavioral change by reducing inpatient diabetes errors in a tertiary children’s hospital.
By focusing our educational efforts on error prevention rather than error disclosure, we have learned a number of important lessons in relation to formal training that leads to the authors’ overarching aim: “long-term effects on learner outcomes that translate into real-world clinical practice.”1 First, implementing diverse methods of instruction rooted in adult learning principles that incorporate different learning styles was a very effective approach. Second, having multiple sessions allowed for facilitator feedback and reflection by trainees. Third, understanding that skills and knowledge can deteriorate over time, a booster session six months after the initial presentation of the curriculum diminished the possibility of an increase in errors. Fourth, providing online modular learning materials for residents who may not be on-site or may not be available because of limited duty hours was important. In sum, we believe that curricula employing androgogic principles to prevent initial errors offered in conjunction with teaching error disclosure may be the most effective teaching approach to promote better patient outcomes.
Fran Cogen, MD
Director, Childhood and Adolescent Diabetes Program, Children’s National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; firstname.lastname@example.org.
Larrie Greenberg, MD
Internal consultant, George Washington University School of Medicine and Health Sciences, Washington, DC.
1. Stroud L, Wong BM, Hollenberg E, Levinson W. Teaching medical error disclosure to physicians-in-training: A scoping review. Acad Med. 2013;88:884–892
2. DeSalvo DJ, Greenberg LW, Henderson CL, Cogen FR. A learner-centered diabetes management curriculum-reducing resident errors on an inpatient pathway. Diabetes Care. 2012;35:2188–2193