Teaching interprofessional health science students medical error disclosure

Context and setting Most doctors agree that medical errors that cause harm should be disclosed to patients. However, the disclosure of errors remains uncommon: only 1 in 4 errors are disclosed. Full disclosure involves a communication between a health care provider and the patient or a family member which acknowledges the error, explains what occurred, and describes the link between the error and unintended outcome in a manner which is meaningful to the patient. The aims of this study were to pilot-test and evaluate an educational module implemented for the purpose of improving students’ confidence in understanding and performing the disclosure of a medical error, and the role of full disclosure of errors in promoting patient safety. Why the idea was necessary When a medical error occurs, its full disclosure is a medical professional responsibility and is essential to patient safety. However, there is little teaching in undergraduate medical or health science education that focuses on this important but complex issue. In response to the identified gap in training, a medical error disclosure training module was developed and piloted as part of a 2-week interprofessional patient safety elective. What was done The module was designed to establish competency in the 4 ‘Rs’ of apology: recognition; responsibility; regret, and remedy. Students were assigned relevant reading materials prior to the in-class training. They attended a 3-hour educational session which included an interactive lecture, use of a full-disclosure training DVD, practice in disclosing an error using standardised patients (SPs), participation in a root cause analysis, and a guided reflection session with the course directors. Students were assessed pre- and post-training using a self-administered confidence survey developed for the course and through performance during a pre- and post-medical error case using an SP. Eighteen students participated. They represented 5 health science disciplines and were all in their last year of study. Complete pre- and post-training data were available for 14 students. Evaluation of results and impact Confidence among students improved significantly from 11.5 ± 2.9 (range 4-16 possible) before to 15.3 ± 1.3 after the module (P < 0.0001). The greatest changes in confidence were observed in the students’ perceived ability to understand and perform a full disclosure (mean 1–1.5-point change; P < 0.0001). In the pre-course SP case, all 14 participants (100%) failed to include the 4 essential elements of full disclosure and 13 (93%) failed to deliver an apology. In the post-course SP case, only 2 (14.3%) participants failed to include the essential elements of disclosure and only 1 (7.1%) failed to deliver an apology. The full-disclosure educational module improved students’ self-perceived confidence about admitting errors and about their understanding of and performing a full disclosure of a medical error. Additionally, students demonstrated significant positive changes in their behaviour and in their ability to effectively disclose a medical error to a patient. The results of this study suggest that the medical error full-disclosure training module is both effective and valuable to students across multiple health science disciplines. It will be incorporated into future patient safety education at this university.