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Medical Error Disclosure: An Entrustable Professional Activity During an Objective Standardized Clinical Examination

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Summary

Medical students improved their skills and confidence in disclosing medical errors after participating in an objective standardized clinical exam (OSCE) and debriefing. This training is crucial for future physicians to effectively communicate errors.

Keywords:
Case-Based LearningClinical Skills Assessment/OSCEsCompetency-Based Medical Education (Competencies, Milestones, EPAs)EPAError DisclosureProfessionalismQuality Improvement/Patient SafetyStandardized Patient

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Area of Science:

  • Medical Education
  • Patient Safety
  • Healthcare Communication

Background:

  • Medical errors are common, necessitating formal training for physicians in error disclosure.
  • Current curricula may lack structured approaches to teaching medical error disclosure skills.
  • Effective disclosure is vital for maintaining patient trust and improving healthcare quality.

Purpose of the Study:

  • To assess the competence of fourth-year medical students in disclosing medical errors using a skills-based objective standardized clinical exam (OSCE).
  • To evaluate the impact of the OSCE and subsequent debriefing on students' knowledge, skills, and attitudes regarding error disclosure.
  • To determine the feasibility of adapting this training module for broader implementation in medical education.

Main Methods:

  • A formative, skills-based OSCE was designed for fourth-year medical students focusing on error disclosure.
  • Faculty evaluated student performance using a checklist during simulated patient encounters.
  • Students received immediate feedback, participated in case-based discussions, role-playing, and self-care reflection, followed by a pre/post survey.

Main Results:

  • 73% of students completed a pre/post survey; 62% initially failed to identify the error in the simulation.
  • Students who identified the error were significantly more likely to use the two-patient identifier (p < .001).
  • Self-reported comfort, confidence in disclosure, and self-care practices significantly improved post-intervention (p ≤ .005).

Conclusions:

  • The OSCE and structured debriefing significantly enhanced medical students' self-reported comfort, confidence, and knowledge in disclosing medical errors.
  • The developed OSCE and case-based experience provide a valuable, adaptable model for medical error disclosure training.
  • Formal training in error disclosure is essential for equipping future physicians with critical patient safety communication skills.