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使用标准化患者对急诊住院医师进行医疗错误披露教育计划。

Education program on medical error disclosure for emergency medicine residents using standardized patients.

机构信息

Department of Emergency Medicine, Chung-Ang University College of Medicine, Seoul, Korea.

Department of Medical Education, Yonsei University Wonju College of Medicine, Wonju, Korea.

出版信息

Korean J Med Educ. 2022 Mar;34(1):1-16. doi: 10.3946/kjme.2022.215. Epub 2022 Mar 1.

Abstract

PURPOSE

We aimed to develop a program for error disclosure for emergency medicine (EM) residents to determine its effects.

METHODS

Fifteen EM residents participated in 2020. The program included two-error disclosure sessions using standardized patients (SPs), a didactic lecture, and debriefing. The Kirkpatrick model was used to evaluate this program. Satisfaction scores and narrative reactions were collected (level 1). Residents were asked to choose their actions and explain reasons for the representative error cases before and after the program (level 2). After 2 months, they were asked to write their experiences of disclosing errors to real patients (level 3). The differences in the disclosing communication scores allocated by the SPs were compared between the senior and junior residents.

RESULTS

The residents' satisfaction scores were high. Before the program, some residents chose not to disclose errors when there were no harmful sequelae at the time of the incident. After the program, opinions changed, and the residents thought that all errors should be disclosed. Before the program, most residents disclosed the errors to patients first; after the program, they would report to the hospital first to receive guidance. After 2 months, five residents reported disclosing errors to real patients. The senior residents' total scores and the scores for "prevention of future errors" were higher.

CONCLUSION

The residents showed confidence in error disclosure while maintaining rapport with the real patient, and some were satisfied with their disclosure approach. Our error disclosure program for EM residents had a positive effect on their behavior and attitude toward error disclosure.

摘要

目的

我们旨在为急诊医学(EM)住院医师开发一个错误披露计划,以确定其效果。

方法

2020 年,15 名 EM 住院医师参与了该计划。该计划包括使用标准化患者(SP)进行两次错误披露会议、一次讲座和一次汇报。采用柯克帕特里克模型评估该计划。收集满意度评分和叙事反应(一级)。住院医师被要求在计划前后选择他们的行动并解释代表错误案例的原因(二级)。两个月后,他们被要求写下向真实患者披露错误的经历(三级)。比较 SP 分配的披露沟通评分在高级和初级住院医师之间的差异。

结果

住院医师的满意度评分很高。在计划之前,当事件发生时没有有害后果时,一些住院医师选择不披露错误。计划后,意见发生了变化,住院医师认为所有错误都应该披露。在计划之前,大多数住院医师首先向患者披露错误;计划后,他们会先向医院报告以获得指导。两个月后,有 5 名住院医师向真实患者报告了错误。高级住院医师的总分和“预防未来错误”的分数较高。

结论

住院医师在与真实患者保持融洽关系的同时对错误披露充满信心,并且对他们的披露方法感到满意。我们为 EM 住院医师设计的错误披露计划对他们的错误披露行为和态度产生了积极影响。

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A Cross-Specialty Examination of Resident Error Disclosure and Communication Skills Using Simulation.
J Grad Med Educ. 2018 Aug;10(4):438-441. doi: 10.4300/JGME-D-17-00603.1.
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Simul Healthc. 2018 Apr;13(2):107-116. doi: 10.1097/SIH.0000000000000273.
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Eur J Emerg Med. 2017 Apr;24(2):108-113. doi: 10.1097/MEJ.0000000000000308.
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Simulated disclosure of a medical error by residents: development of a course in specific communication skills.
J Surg Educ. 2014 Nov-Dec;71(6):e116-26. doi: 10.1016/j.jsurg.2014.06.020. Epub 2014 Aug 22.
10
Teaching medical error disclosure to residents using patient-centered simulation training.
Acad Med. 2014 Jan;89(1):136-43. doi: 10.1097/ACM.0000000000000046.

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