Medical students, interns, and residents need training to disclose medical errors
Research Activities October 2011, No. 374
Although patients say they want health care providers to promptly disclose and apologize for errors made while patients are under their care, surveys suggest that a minority of harmful errors are disclosed to patients. What's more, disclosure conversations often fail to meet patients' expectations. In fact, a recent survey reveals that the disclosure content chosen by 758 medical students, interns, and residents falls short of current disclosure guidelines.
The researchers surveyed medical students in various stages of training at two universities that did not require error-disclosure training. The survey used two hypothetical scenarios, one involving an obvious insulin overdose, and the other involving hyperkalemia (excessively high potassium levels in the blood), an error less apparent to the patient. Questions focused on how likely the medical trainee would be to disclose the error and what they would most likely say.
Most trainees (85 percent) agreed that their scenario represented a serious error. A majority (78 percent) felt that, as the doctor, they would be very or extremely responsible for the error in the scenario. Trainees reported their intent to disclose the error as "definitely" (43 percent), "probably" (47 percent), "only if asked by the patient" (9 percent), and "definitely not" (1 percent). Trainees were more likely to disclose obvious errors than errors that patients were unlikely to recognize (55 vs. 30 percent). Respondents were split between conveying a general expression of regret (53 percent) and making an explicit apology (46 percent). More experienced respondents were less likely to provide an explicit apology.
The information respondents would disclose largely mirrored that chosen by doctors surveyed by the researchers in prior studies. Yet, only a minority of medical students receive training in error disclosure. The researchers conclude that the current training environment may not encourage an approach to error disclosure that is consistent with patient expectations and national guidelines. This study was supported by the Agency for Healthcare Research and Quality (HS14012).
See "How trainees would disclose medical errors: Educational implications for training programmes," by Andrew A. White, M.D., Sigall K. Bell, M.D., Melissa J. Krauss, M.P.H., and others in Medical Education 45, pp. 372-380, 2011.