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"To Err Is Human" but Disclosure Must be Taught: A Simulation-Based Assessment Study
Ashley C Crimmins1, Ambrose H Wong, James W Bonz
1From the Department of Emergency Medicine (A.C.C.), University of Maryland School of Medicine, Baltimore, MD; Department of Emergency Medicine (A.H.W., J.W.B., A.T., K.J., J.D.D., L.V.E.), Yale School of Medicine, New Haven, CT; and Department of Emergency Medicine (K.L.D), Hoag Hospital, Newport Beach, CA.
Summary
Physicians show suboptimal adherence to medical error disclosure guidelines. Increased experience correlates with better performance, but additional training is needed for safe disclosure of adverse events.
Area of Science:
- Medical Education
- Patient Safety
- Healthcare Quality Improvement
Background:
- Error disclosure is crucial for patient safety and centered care.
- Physicians receive inconsistent training in error disclosure.
- Objective methods for assessing disclosure competence are lacking.
Purpose of the Study:
- To assess adherence to safe practice guidelines for error disclosure.
- To evaluate provider performance in a simulated adverse event scenario.
- To determine the impact of clinical experience on disclosure practices.
Main Methods:
- Prospective cohort study involving medical students, junior residents, senior residents, and attending physicians.
- Participants engaged in a simulated medication overdose leading to an adverse event.
- Scenarios were videotaped and scored using a 21-point disclosure assessment instrument by expert raters.
Main Results:
- Total disclosure scores improved with increased clinical experience (P=0.03).
- 75% of participants failed to address preventing error recurrence.
- Only 23% offered an apology during initial disclosure; 56% required prompting.
Conclusions:
- Healthcare providers demonstrated suboptimal adherence to best practices for error disclosure in a simulation setting.
- While experience correlates with performance, additional training is necessary.
- Simulation provides a valuable tool for assessing and improving disclosure competence.