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Patient Safety and Quality

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Few medical trainees are trained to disclose errors to patients by the time they assume some patient care

Few medical trainees have been formally prepared to disclose errors to patients by the time they are faced with the challenge, finds a new study. Although a few medical schools provide formal instruction in error disclosure, these skills are largely taught via the hidden curriculum and role modeling during internships and residencies. To measure trainees' attitudes and experiences regarding medical error and error disclosure, Thomas H. Gallagher, M.D., of the University of Washington School of Medicine, and colleagues surveyed second- and fourth-year medical students, medicine and surgery interns, and medicine and surgery residents.

Of the 889 trainees who responded to the survey, most (74 percent) agreed that medical error is among the most serious health care problems. Nearly all (99 percent) agreed serious errors should be disclosed to patients, but 87 percent acknowledged barriers to disclosure such as the patient's lack of understanding or the threat of a lawsuit. Personal involvement with medical errors was common among the fourth-year medical students (78 percent) and the residents (98 percent). Among residents, 45 percent reported involvement in a serious error, 34 percent reported experience disclosing a serious error, and 63 percent had disclosed a minor error. Although only 33 percent of trainees had received training in error disclosure, 92 percent expressed interest in such training, particularly at the time of disclosure.

To improve the frequency and content of error disclosure as well as to maintain public trust, the next generation of physicians must be prepared to properly disclose medical errors, the researchers recommend. They call for development of formal disclosure curricula, coupled with supervised practice, to prepare trainees to independently disclose errors to patients by the end of their training. Their study was supported in part by the Agency for Healthcare Research and Quality (HS11898 and HS14012).

More details are in "The attitudes and experiences of trainees regarding disclosing medical errors to patients," by Andrew A. White, M.D., Dr. Gallagher, Melissa J. Krauss, M.P.H., and others, in the March 2008 Academic Medicine 83(3), pp. 250-256.

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