Always Events: Riverside Methodist Hospital- Teaching Disclosure

Riverside Methodist Hospital
Teaching Disclosure: A Patient-Centered Simulation Training for the Crucial Conversation
Principal Investigator:
Sara Sukalich, MD

The primary aim of this project is to improve residents’ ability to disclose medical errors. Disclosure, the process of bringing to light an unintended outcome, is essential to the nature of the patient-physician relationship. In this project, we are using simulated patient encounters, on-line teaching, self-assessment, and observer assessment to introduce the learners to proper disclosure.

By teaching residents the proper way to disclose medical errors in a simulated situation, we hope to improve their ability to do so when errors happen in clinical situations. Many barriers to successful disclosure exist. These may include communication deficits, fear of malpractice litigation, and difficulty in admitting to mistakes. Disclosure is inherently a difficult and stressful process, perhaps particularly in the young physician. During this simulation, the resident will be able practice disclosure in a safe and supportive environment. All fifty-six of the post-graduate year one (PGY1) residents at Riverside Methodist Hospital participated in a simulation centered on disclosing a medical error to a patient’s family member. The patient, in the scenario, was inadvertently given an overdose of a narcotic, leading to change in status and transfer to an intensive care unit. This is a realistic scenario that allowed the project team to teach and reinforce critical parts of disclosure, such as, clearly explaining the situation, expressing regret, and speaking to what will be done to prevent such an error in the future. Each resident participated in the simulation twice. In the intervening time, each PGY1 completed an on-line teaching module about disclosure.

The project team used a number of tools to evaluate the residents. Each learner completed self-assessments before and after the two simulations. The residents were also formally evaluated by faculty members and the standardized patients. This 360°-evaluation allowed residents to improve knowledge about the process of disclosure, as well as improve communication surrounding the acknowledgement of mistakes and providing an apology for medical errors.

Teaching Disclosure Simulation Development Form

Teaching Disclosure Simulation Flowsheet

Resident Pre-scenario Knowledge Assessment

Resident Self-Assessment Tool

Faculty Assessment Tool

Standardized Patient Assessment Tool

Outside Faculty Assessment Tool




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