Clinical Simulation and Skills Unit, Faculty of Health Sciences, University of the Free State, 205 Nelson Mandela Drive, 9300, Bloemfontein, South Africa.
Department of Biostatistics, School of Biomedical Sciences, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa.
BMC Med Educ. 2023 Mar 28;23(1):191. doi: 10.1186/s12909-023-04125-3.
Despite patient safety initiatives, medical errors remain common and devastating. Disclosing errors is not only ethical, but also promotes restoration of the doctor-patient relationship. However, studies show active avoidance of error disclosure and the need for explicit training. In the South African setting, sparse information exists in terms of undergraduate medical training in error disclosure. To address this knowledge gap, the training of error disclosure in an undergraduate medical programme was examined, against the background of the available literature. The objective was to formulate a strategy to improve error disclosure teaching and practice, with the goal of improving patient care.
Firstly, the literature was reviewed regarding the training of medical error disclosure. Secondly, the undergraduate medical training in error disclosure was probed, by looking at the pertinent findings from a broader study on undergraduate communication skills training. The design of the study was descriptive and cross-sectional. Anonymous questionnaires were distributed to all fourth- and fifth-year undergraduate medical students. Data were predominantly analysed quantitatively. Open-ended questions were analysed qualitatively using grounded theory coding.
Out of 132 fifth-year medical students, 106 participated (response rate 80.3%), while 65 out of 120 fourth-year students participated (response rate 54.2%). Of these participants, 48 fourth-year students (73.9%) and 64 fifth-year students (60.4%) reported infrequent teaching in the disclosure of medical errors. Almost half of the fourth-year students (49.2%) considered themselves novices in error disclosure, while 53.3% of fifth-year students rated their ability as average. According to 37/63 (58.7%) fourth-year students and 51/100 (51.0%) fifth-year students, senior doctors seldom or never modelled patient-centred care in the clinical training setting. These results resonated with the findings of other studies that showed lack of patient-centredness, as well as insufficient training in error disclosure, with resultant low confidence in this skill.
The study findings confirmed a dire need for more frequent experiential training in the disclosure of medical errors, in undergraduate medical education. Medical educators should view errors as learning opportunities to improve patient care and model error disclosure in the clinical learning environment.
尽管患者安全措施不断推出，但医疗差错仍屡见不鲜，且后果严重。披露差错不仅合乎道德，还有助于修复医患关系。然而，研究表明，人们常常回避披露差错，且需要接受明确的培训。在南非，本科生医学培训中有关差错披露的信息非常有限。为填补这一知识空白，我们对本科生医学项目中的差错披露培训进行了研究，并参考了现有文献。我们的目标是制定一项策略，以改进差错披露教学和实践，从而改善患者护理。
首先，我们对医学差错披露培训的文献进行了回顾。其次，我们研究了本科生医学培训中的差错披露情况，研究方法是参考一项更广泛的本科生沟通技巧培训研究中的相关发现。该研究的设计为描述性和横断面研究。我们向所有四年级和五年级医学生发放匿名问卷，主要对定量数据进行分析，对开放式问题则采用扎根理论编码进行定性分析。
在 132 名五年级医学生中，有 106 名（应答率 80.3%），在 120 名四年级学生中，有 65 名（应答率 54.2%）参与了调查。其中，四年级学生中有 48 名（73.9%）和五年级学生中有 64 名（60.4%）报告说，他们很少或从未接受过医疗差错披露方面的教学。近一半的四年级学生（49.2%）认为自己在差错披露方面是新手，而 53.3%的五年级学生则认为自己的能力一般。根据 37/63（58.7%）名四年级学生和 51/100（51.0%）名五年级学生的说法，高年级医生在临床培训环境中很少或从不树立以患者为中心的护理榜样。这些结果与其他研究的结果一致，这些研究表明，以患者为中心的护理以及差错披露方面的培训不足，导致学生对此技能缺乏信心。
研究结果证实，本科生医学教育中非常需要更频繁地进行医学差错披露方面的体验式培训。医学教育者应将差错视为改善患者护理和在临床学习环境中树立差错披露榜样的学习机会。
