Disclosure of Medical Errors as Part of a Patient Safety Medical School CurriculumPosted: August 4, 2012
In my last post, I shared how patient safety education started on the first day of medical school during my time at UIC. The very first meeting with students began with a discussion on medical student fears…which always led to a discussion about patient harm. Their first two years of medical school had numerous sessions on patient safety embedded into the curriculum. Education on disclosure of medical harm was one track within that safety curriculum.
The summer before classes started, our first year students were required to read a book. Each year while I was there, we alternated the summer reading between a book on professionalism and Rosemary Gibson’s book, Wall of Silence. Wall of Silence shares the stories of patients who were unintentionally harmed by a medical error. Instead of focusing on the error in a way root cause analyses or historical M&M conferences do, Rosemary interviewed patients and families about what they want from healthcare providers after they, or their loved one, was harmed. The stories highlight a number of common themes patients and family members expect from caregivers after harm has occurred which include:
- Share all the facts and answer questions honestly
- If appropriate, apologize for any mistake that was made
- Provide a remedy for the harm (“benevolent gesture”)
- Show them what you have learned from the mistake, and how you will change your health system so no one suffers similar harm.
Having students read Rosemary’s book set the stage for productive patient safety discussions over the course of their first two years. Many students said they found the patient safety plenaries and discussions a refreshing departure from the large number of basic science lectures they had to endure in their pre-clinical years. While most of the students struggled to understand issues related to clinical care that led to the error, they easily grasped the human side of the conversation. They appreciated why patients wanted honesty and apology when mistakes had been made, and they also understood why patients and families wanted to know what we learned from the mistake and how we were going to change our care systems so that others were not harmed in a similar way. They acknowledged these were qualities of caring and compassionate caregivers.
During our discussions, many students would share personal stories of their own family members who had been harmed from care and how they had been treated after the harm. Tim McDonald and I would lead discussions on the multiple barriers in place making it very difficult for physicians to meet their patients wishes when harm occurred–malpractice, loss of license, shame and blame culture, etc. Even with AMA ethics statements, Joint Commission requirements on disclosure, and newer data on the successes seen with disclosure and rapid remedy programs implemented at Michigan, UIC and others across the country, most physicians still hide, and even lie to patients to keep medical errors secret. The students received the educational message on the importance of open and honest disclosure after a harm event, but they also appreciated the barriers still in place making it difficult for excellent and caring physicians to disclose an error and apologize.
These sessions, and the readings on disclosure of medical errors were part of our curricular goal for the first two years of our students’ medical education. We wanted them to engage in these types of conversations so they would KNOW about medical errors, about disclosure after harm, and about right and wrong. For our health science students to exist in a learning environment that discourages open and honest discussion between caregivers and their patients, and asks the students to ignore what they see being practiced when they know it is not the right thing to do is no way to start a career in medicine, yet this is what has gone on for many years. The students are smart enough to know right from wrong…yet when it comes to patient harm, they “grow up” watching role-models exhibit the poor behaviors we have practiced for too long
In subsequent posts, I will share elements of the third and fourth year curriculum we developed at UIC related to disclosure. Our goal was to move the students from “KNOWS” to “KNOWS HOW TO” in acquisition of learning.