Council on Medical Student Education in Pediatrics


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COMSEP Meeting in Ottawa, ON

Poster Presentation:

Saying You're Sorry: Medical Error Disclosure Training for Medical Students

Miriam Schechter,Albert Einstein College of Medicine/Childrens Hospital at Montefiore,Bronx,NY,Hai Jung Helen . Rhim,Albert Einstein College of Medicine/Childrens Hospital at Montefiore,Bronx,NY,Michael Rinke,Albert Einstein College of Medicine/Childrens Hospital at Montefiore,Bronx,NY,Jillian . Parekh,Albert Einstein College of Medicine/Childrens Hospital at Montefiore,Bronx,NY,Jenna Scholnick,Albert Einstein College of Medicine/Childrens Hospital at Montefiore,Bronx,NY,Theresa Serra,Albert Einstein College of Medicine/Childrens Hospital at Montefiore,Bronx,NY,Emily . Spengler,Albert Einstein College of Medicine/St. Barnabas Hospital,Bronx,NY

Background:Medical errors are common and patients want to know when they occur.1,2,3 Attendings, residents and students want and need additional medical error disclosure (MED) training.4,5 A simulation-based intervention in medical school may improve disclosure confidence and abilities.6,7

Objectives:Determine if a simulated interprofessional family meeting improves studentsÂ’ knowledge, attitudes and self-predicted behaviors in MED.

Results:We used mixed methods to evaluate the curriculum: 1)before-after study with a historical control group for comparison, examining knowledge and attitudes about MED and using medical error vignettes to predict behavior, 2)qualitative analysis of the studentsÂ’ reflective pieces and 3)anonymous post-exercise satisfaction survey.

The study group(SG) was more likely than the control group(CG) to know 4 key points to convey in MED(p=0.01), was less likely to say no disclosure was necessary for various scenarios(p=0.03) and included more key points of MED in what they would say to the patient(p<0.05).

Qualitative analysis of the reflective pieces revealed 3 themes: internalization(extreme difficulty of the case, psychological/emotional effects), externalization(team relations regarding an error, need for systems changes), and ethical imperative(honesty, apology).

On the survey, 79% of 190 students felt the activity was very useful in increasing ability to describe effective strategies for MED and 96% felt the exercise increased comfort with MED.Discussion: This simulated family meeting improves 3rd year medical studentsÂ’ knowledge and comfort in MED and may affect future practice.

The exercise is a low cost initiative but requires a faculty member knowledgeable in medical errors and second victim. Preparatory materials and the scenario are transferable to others.

This simulation provides what may be the only opportunity for students to practice MED. Care must be taken to debrief the students afterwards due to the intensity and difficulty of the scenario.