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Authors Institution
Punnapop Emsiriratn
Kantawit Suantawee
Sittinun Thangjui
Wissarut Sakulpaptong
Theerawut Wongjeeraphat
Chitsanu Pancharoen
Chulalongkorn University, Faculty of Medicine
Theme
Patient Safety
Teaching disclosure of medical errors to pre-clinical students: a pilot study at Chulalongkorn medical school
Background

          Disclosure of medical errors is a required competence in medical ethics section of Thai medical council's standards for general practitioner[1] . However, the teaching and training of this topic might be lacking in some medical school[2] . At Chulalongkorn medical school, a group of 2nd year medical students chose to pursue their learning in this topic as a project in 'Medical Ethics & Critical Thinking' course.

Summary of Work
Summary of Results

      Overall, the performance scores correlated negatively with the difficulty of scenarios. The three skills with the highest scores are (1)Apologize and/or express regret (2)Use simple and polite language and (3)Be attentive and understand what the patients' need. The three skills with the lowest performance scores are (1)Maintain the patients' confidence in one's ability (2)Open conversation and (3)Convince patients to accept the medical errors. Moste students had more understanding of how to disclose medical errors. More importantly, they learned from both doctor's and patient's perspectives from the same event.


 

 

Conclusion

Role-playing in the OSCE-style with feedback and reflection is the powerful tool to each medical errors disclosure.

Acknowledgement

         The authors are grateful to thank my thesis advisor, Dr. Thanyawee Puthanakit for her invaluable help and encouragement throughout the course of this research. We would not have achieved this far and this project would not have been completed without all the support from her.

          In addition, the authors would like to express our sincere thanks to Dr. Danai Wangsaturaka for suggestions and all his kindly helps.

          Finally, the authors unforgettably to thank participants who join this program. 

References

          [1] Thai Medical Council. Medical Competency Assessment Criteria for National License 2012. DOI: http://www.tmc.or.th/file_08062012.pdf

          [2] Ali A A. Communication skills training of undergraduates. Journal of the college of physicians and surgeons Pakistan 2013;23:10-5

          [3] Posner G. Assessing resident's communication skills: disclosure of an adverse event to a standardized patient. JOGC 2011:262-8. DOI: http://jogc.org/abstracts/full/201103_Education_1.pdf

Take-home Messages

          For preclinical students, role playing in the OSCE-style with feedback and reflection may provide a new strength in teaching medical error disclosure and other communicatin skills.

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Background
Summary of Work

This study was a project in 'Medical Ethics & Critical Thinking' course of Faculty of Medicine, Chulalongkorn University,Thailand. Thirty 2nd year pre-clinical students voluntarily joined the 2- day workshop held on 5th and 6thJanuary, 2013 at a resort in Nankhonnayok Province, Thailand.There were three main steps in the workshop as following. 

Step 1

First, an hour interactive lecture of the principle of communication was introduced to the students by the experienced communication trainer. The students were then divided into two groups: doctors’ group and patients’ group.Small group lectures combined with interactive discussion and exercises were separately conducted by 2 experienced trainers before role-playing in the Objective Structured Clinical Examination(OSCE) format.

 

 

         Step 2

There were five scenarios, arranged in order by severity, including:

I. Giving wrong insulin dosage;
II. Reporting false positive HIV test results;
III. Intraoperative complication during abdominal surgery;
IV. Birth asphyxia when the doctor in charge not available;
V. Unrecognized history of antibiotic hypersensitivity causing patient’s death.


The doctors and the patients were divided into 3 loops. Each doctor was asked to disclose 5 different medical errors in 10-minute OSCE station. In addition to being assessed by 5 patients, each doctor also assessed his own performance.

 

Step 3

There were small group discussions separately among doctors and patients after the OSCE. At the end, they discussed together to find the best way to disclose and reflect on what they had learned from the workshop.

 

 

The questionnaire was modified from Posner study [5]. The intent of the assessment is to evaluate the satisfaction in each of 15 performed tasks and overall performance; rating scale is 0-3 and 0-10, respectively. Microsoft Excel 2007 and SPSS Version 17.0 were used for the statistical analyses to find average mean for each skill and internal-consistency (Cronbach's alpha) of the questionnaire.

Summary of Results

OSCE results

 


Noticeably, the overall satisfaction scores regressively correlated with the severity of the scenarios. The Cronbach's alpha coefficient of the questionnaire is 0.851.

 

 

 

 


Brainstorming Result

 

 

All preclinical medical students in this study together proposed the steps for disclosing medical error. 

1. Empathically listen to the patients
2. Accept your own medical errors
3. Say sorry sincerely
4. Take responsibilities 


          Moreover, most students had more understanding of how to disclose medical errors and its importance. They learned from both doctor's and patient's perspectives from the same event. Noticeably, most students learned how medical errors impacted patients’ lives and realized minimizing them was essential. Some were aware of real clinical errors and wanted more practice to communicate better.


  

        

    

 

 
Conclusion
Acknowledgement
References
Take-home Messages
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