Background: Medical errors are the third leading cause of death in the United States yet physicians report minimal education on how to disclose errors and adverse events. To Err is Human shed light on the severity of errors. As a result, communication and resolution programs were developed over the past two decades to attempt to bridge that gap. However, studies and surveys of both physicians and patients alike revealed that it is insufficient.
Purpose: We designed a curriculum to address this gap to provide physicians with the tools to care for their patients, themselves and each other in the aftermath of these events. By destigmatizing error, we help to cultivate a culture of safety rather than one of blame, where physicians feel confident to recognize, disclose and prevent future errors, as well as providing them with the skills to support one another when they occur.
Description: Three workshops were provided to medical students, residents, faculty and non-physician providers. Sessions were presented in a hybrid workshop format for one hour. The goals were to: 1) Appreciate the role patient safety plays in the delivery of equitable care. 2) Recognize that error disclosure is a professional obligation and to 3) value self-care practices following an error. Learning objectives were to 1) Define Psychological Safety, 2) Describe the components of error disclosure, 3) Perform the skill of error disclosure and 4) Provide support to a colleague involved in an error. The interactive workshop was divided into four parts with parts 1-3 delivered over twelve-minute intervals and part four allocated the remaining 24 minutes. Part one discussed psychological safety, professional identity formation and high functioning teams. Part two included the nature of errors, patient and physician perspectives and established a framework for disclosing errors to patients and families. Part three educated participants on second impact syndrome, peer support and vicarious bereavement. Part four consisted of case studies where participants divided into groups to role-play scenarios, provide feedback and ask questions. Seventy-two participants were surveyed regarding their confidence with error disclosure via an online form. The pre-intervention survey had a response rate of 86.11% and the post intervention survey had a response rate of 44.44%. Of the total respondents: 2 were medical students, 18 were residents, 12 were fellows, 26 were attending physicians and 4 were NPPs. Respondents rated the following six statements with agree, strongly agree, neither agree nor disagree, disagree or strongly disagree in pre and post workshop surveys.
Conclusions: Results were as follows: 1. It is essential for healthcare providers to know how to disclose an error: 98.4% agreed vs 100%. 2. I know how to disclose an error to a patient and/or patient’s family: 66.1% agreed vs 96.9% 3. Health care providers should apologize to patients following an error: 75.8% agreed vs 96.9% 4. I feel comfortable disclosing an error to a patient: 48.4% agreed vs 90.6% 5. I feel comfortable supporting a colleague involved in an error: 32% agreed vs 100%. 6. I feel confident that I can identify an error: 82% agreed vs 100%. While most healthcare providers agree that they should know how to disclose errors, there is a significant lack of confidence in how to do so. Further gaps are elucidated in the identification of errors, the importance of an apology and peer support. Implementing a disclosure curriculum imparts valuable skills to physicians across the continuum and is welcomed by team members.
