Disclosure of Medical Errors as Part of a Patient Safety Medical School Curriculum – Third YearPosted: August 8, 2012
In my previous posts this past week, I described the first two years of the medical error disclosure educational track that was part of our four-year patient safety medical school curriculum at UIC. The goal for the first two years was to engage our students in readings, discussions and case-based learning so they were aware of, and appreciated, the medical error crisis, understood the deny and defend approaches previously used, and gained insights on newer disclosure, apology and rapid compensation models being adopted by a growing number of hospitals across the country.
In the third year of medical school, we brought additional case-based learning to our educational efforts. We had a number of historic internal cases that were used as examples on how we did it wrong – causing an additional “harm after harm” – by not being honest, having our lawyers “defend the indefensible” and hoping patients and families who had been harmed by our care would just give up trying to get the answers and remedies they deserved.
In addition, we spent significant time in the third year of medical school addressing informed consent with our students who now were engaged in their clinical care rotations. Open and honest communication is critical to any successful informed consent or true “shared decision-making”. The patient safety film “The Faces of Medical Error…From Tears to Transparency: The Story of Michael Skolnik is an excellent educational tool to begin this discussion. In the film, Rick Boothman, Chief Risk Officer for the University of Michigan Health System, introduces the film by saying:
I think it’s absolutely critical to understand that transparency begins with the informed consent concept…with a commitment to reach a patient on every level and that disclosure…is simply nothing more than a commitment to be honest with patients from the beginning and throughout that therapeutic relationship.
Harlan Krumholz, MD, Harold Hines Jr. Professor of Medicine (Cardiology) at Yale University continues the conversation in the film by sharing:
We have many patients who are having prescriptions or procedures or large surgeries that they would not necessarily choose if they understood all the facts. And that’s what we’ve got to fix in medicine. We’ve got to make sure that the choices that are being made are completely aligned with the patient’s needs, values, preferences and goals, and they are making the choice…We’ve got to give them the facts, and make sure we’re making the choices together that are right for them.
Issues related to informed consent and shared decision-making are fundamental to any efforts focused on open and honest communication in healthcare. True informed consent is a process that begins with a transparent sharing of information – an effective and honest communication between patient and caregiver. To support the educational messaging of the film, we shared with students related critical readings. One of the best overviews was Harlan’s JAMA commentary from March 2010 on Informed Consent and Patient Centered Care, in which he suggests a new and improved informed consent process which provides the patient with:
- An explanation of the procedure or test
- Potential Benefits
- Potential Risks
- Other Available Treatment
- Experience of Your Health Care Team
The students enjoyed these discussions and shared their concerns about what they saw role-modeled by some physicians and residents. They also understood why these meaningful conversations around procedures and treatment options were an important foundation for any true patient-centered care model. We knew our curriculum was quite different from other medical school and residency trainings programs, and the lack of training in informed consent and shared decision-making was especially evident during this year’s Telluride Patient Safety Student and Resident Summer Camps. (See post by Paul Levy, Telluride Day 2 – Informing Consent).
In my next post, I will share the final component – the capstone – of our four-year medical school curriculum on disclosure of medical errors. It is our belief that educating future physicians about the importance of open and honest communication when patient care causes unintentional harm is most certainly more than a 50 minute, one-time plenary.