Disclosure Training is a Process, Not a Fifty Minute Lecture

Since Paul Levy’s post,  Attitudes are one thing, behavior is another, and my follow-up post, Are Interns Really Willing to Disclose Medical Errors? generated much interest on the topic of resident physician and medical student attitudes and education related to medical error disclosure , I’d like to continue with this important patient safety educational theme.

When I was academic dean at the University of Illinois College of Medicine in Chicago, a number of us designed and implemented a four-year patient safety curriculum for our medical students. In 2006, this was one of the first (if not, the first) four-year, longitudinal patient safety curriculum for medical students in the country. Our curricular work was supported by grant funding provided by the Foundation for Improvement in Post Secondary Education (FIPSE).

One educational component of the four-year patient safety curriculum was dedicated to disclosure and apology related to medical errors. The disclosure training was based on our “Seven Pillars” model that the University had put in place. The “Seven Pillars” model includes: a rapid response to all unanticipated outcomes, full disclosure related to the care, apology and early compensation if warranted, and using transparency and disclosure to learn from all our mistakes so that we implemented the necessary changes to our system to reduce risk to others. This model has become well-known throughout the country, and was recently referenced by Dr. Carolyn Clancy, the Director of AHRQ, in her July 12th consumer article, Revealing Medical Errors Helps Chicago Hospitals Build a Safer Health System.  The “Seven Pillars” approach uses the court system as a last resort (versus the first thing we historically ran to, or hid behind) in bringing closure to patients, families and caregivers.

The disclosure training programs for students put in place while I was at UIC had a number of core elements to it. We started the very first day of school at 8:30am with a patient safety conversation with our students. Before they received their first biochemistry lecture, I led an interactive, one-hour session with our new students on their “expectations” related to medical school. I did this session for five years, and every year it was a very rewarding and informative session for me as an academic dean. I really enjoyed connecting with the students on the first day of their four years with us, and hearing their thoughts on what they perceived the next four years of their lives would be like.

During the first half of the hour-long session, I always asked the students to share with me the fears they had on this first day of school, the starting point on their journey to becoming a physician.  Each year I did this, two fears rose to the top – the fear of failure and the fear of hurting a patient. Students read the newspapers that share personal stories of harm or talk about the medical error crisis; many students had a family member harmed from a medical mistake. As an educator, it was a great teaching moment to start the safety conversation, and the reason why we started the conversation on the very first day of school. More on the safety curriculum and disclosure training we created for our students and residents tomorrow.

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