A Cross-Specialty Examination of Resident Error Disclosure and Communication Skills Using Simulation

Disclosure of medical errors is important to patients and physicians, but formal disclosure training during the graduate medical education curriculum is limited.

We examined resident competence related to error disclosure, using standardized patient (SP) ratings of resident communication skills.

All first-year residents from medicine, radiology, emergency medicine, orthopedic surgery, and neurological surgery completed a 20-minute simulated session in which they were provided background information on a medical error they had made and were asked to disclose the error to an SP acting as a family member. Residents were then debriefed and completed a postscenario questionnaire. The SPs completed an 11-item communication assessment and 3 milestone rating tools on professionalism (PROF-1, PROF-3) and interpersonal and communication skills (ICS-1).

Ninety-six residents from a single institution participated toward the end of the intern year. Communication assessment scores ranged from 23% to 100% (mean [SD], 80.6 [17.0]). Mean (SD) milestone ratings across specialties were 2.80 ± 0.92 for PROF-1, 2.48 ± 0.92 for PROF-3, and 2.45 ± 0.92 for ICS-1. One-way analysis of variance revealed no significant differences among specialties on milestone or communication ratings. Residents who accepted personal responsibility for the error (84.55 [14.06]) received significantly higher communication ratings from SPs compared with residents who did not (66.67 [19.52], P < .001).

This SP assessment of error disclosure by first-year residents from multiple specialties was feasible and acceptable. It revealed areas of improvement as well as considerable variation in communication skills and professionalism among residents.