Learning Through Experience: Influence of Formal and Informal Training on Medical Error Disclosure Skills in Residents.

BACKGROUND

Residents' attitudes toward error disclosure have improved over time. It is unclear whether this has been accompanied by improvements in disclosure skills.

OBJECTIVE

To measure the disclosure skills of internal medicine (IM), paediatrics, and orthopaedic surgery residents, and to explore resident perceptions of formal versus informal training in preparing them for disclosure in real-world practice.

METHODS

We assessed residents' error disclosure skills using a structured role play with a standardized patient in 2012-2013. We compared disclosure skills across programs using analysis of variance. We conducted a multiple linear regression, including data from a historical cohort of IM residents from 2005, to investigate the influence of predictor variables on performance: training program, cohort year, and prior disclosure training and experience. We conducted a qualitative descriptive analysis of data from semistructured interviews with residents to explore resident perceptions of formal versus informal disclosure training.

RESULTS

In a comparison of disclosure skills for 49 residents, there was no difference in overall performance across specialties (4.1 to 4.4 of 5,  = .19). In regression analysis, only the current cohort was significantly associated with skill: current residents performed better than a historical cohort of 42 IM residents ( < .001). Qualitative analysis identified the importance of both formal (workshops, morbidity and mortality rounds) and informal (role modeling, debriefing) activities in preparation for disclosure in real-world practice.

CONCLUSIONS

Residents across specialties have similar skills in disclosure of errors. Residents identified role modeling and a strong local patient safety culture as key facilitators for disclosure.