Owning Difficult Outcomes: Navigating Medical Error Disclosure for Trainees in Accordance With ACGME Standards

The American College of Graduate Medical Education (ACGME) mandates that physicians promote patient safety and high-quality care, including training trainees in disclosing adverse events to patients and families. Despite its importance, many trainees lack formal preparation in error disclosure, leading to inconsistent practices. Structured training programs are essential to meet societal expectations and professional responsibilities.

A simulation-based curriculum was integrated into our annual "Difficult Communications" simulation day in response to feedback from residents. The curriculum employs standardized patients to create realistic error disclosure scenarios. Sessions include pre-briefing with faculty facilitators and standardized patients, simulated encounters, and structured debriefings. Trainees participate as primary discussants and observers, receiving feedback from peers, faculty, and standardized patients. The program ensures that each member engages in at least 1 error disclosure simulation during their training.

Sessions involved 12-18 learners annually as primary discussants and 6-12 as observers. Senior trainees who had not previously led a session were prioritized as discussants. There was a significant difference in confidence levels before (3.88 ± 0.60) and after (4.76 ± 0.56) the simulation, indicating a significant increase (P = .0006). Learners valued the structured debriefing and the opportunity to practice in a safe environment.

The simulation-based curriculum effectively enhances trainees' skills in error disclosure, aligning with ACGME requirements and fostering patient-centered care. Despite the positive outcomes, limitations included faculty availability and time constraints. Future steps include expanding the case bank, enhancing faculty training, and measuring real-world application. This curriculum represents a significant advancement in preparing residents for disclosing medical errors.