Meeting the Milestones through Simulation: Disclosing a Medical Error
Correspondence should be addressed to Cari Halacoglu, DO at cari.halacoglu@gmail.com
DOI: https://doi.org/10.5070/M5.53010
ABSTRACT:
Audience: This simulation is intended for medical students, interns, junior residents, and senior residents.
Introduction: Patient safety event reporting and disclosure of medical errors to patients and families are critical components of high-quality, transparent care and a necessary skill for emergency medicine (EM) physicians. Accurate reporting of errors, near misses, and unsafe conditions provides institutions with the data needed to investigate vulnerabilities, implement system-based solutions, and prevent recurrence. Disclosure of medical errors fosters trust, supports just culture principles, and reinforces professional accountability.1 Physicians have historically reported few adverse events, accounting for only 1–2% of all reports.2 To address this gap, the Accreditation Council for Graduate Medical Education (ACGME) now emphasizes patient safety and quality improvement as a part of resident education.
The ACGME Emergency Medicine Milestones have established clear expectations for resident education in patient safety.3 Residents, fellows, and faculty must know their responsibilities for event reporting. The milestones include ability to identify patient safety events, understand the system factors that lead to events, and how to complete institutional safety event reports.3 ACGME requires residents to participate in real or simulated interprofessional patient safety events and quality improvement activities as part of systems-based practice milestones.3 These requirements underscore the importance of experiential learning, feedback, and practice in order to achieve true competence in identifying causes and enacting sustainable safety interventions.
Medication errors, particularly dosing errors, are among the most common patient safety threats in the emergency department (ED).4 The ED environment—with high patient volumes, time-sensitive decision-making, and frequent weight-based dosing—places EM physicians at especially high risk for ordering or administering incorrect doses. In this simulation, the wrong concentration of a sedation medication is administered and creates a scenario in which the learner must recognize the error, disclose it to the patient/family, and complete a patient safety report (PSR). This approach integrates clinical management with communication and systems-based practice and provides an avenue for residency programs to facilitate ACGME requirements while preparing residents for real-world patient safety responsibilities in scenarios that otherwise may not yet be encountered during the period of residency.
Educational Objectives: By the end of this simulation activity, learners will be able to: 1) disclose a medical error to a patient and/or their family, 2) understand the different types of patient safety events that should be reported, 3) locate the form for disclosing a patient safety event at their institution, and 4) appropriately complete a patient safety report at their institution.
Educational Methods: The simulation was conducted with a high-fidelity pediatric mannikin. A total of 19 residents and three medical students participated in the simulation during their monthly didactic session. Afterwards, they were guided through completing a patient safety report for their institution.
Research Methods: Learners completed a survey before and after the simulation case assessing their comfort with disclosing medical errors and completing an institutional patient safety report form. The survey questions were formatted in a Likert scale where 1 = strongly disagree, 2 = disagree, 3 = neither agree nor disagree, 4 = agree, 5 = strongly agree. Results collected were analyzed using Wilcox rank-sum test.
Results: The participants completed a survey before and after the experience, and there was a statistically significant improvement in the learners’ comfort level after completing the simulation. The free text responses were also universally positive.
Discussion: Overall, the learners received the simulation well. General feedback was positive; the consensus was that there was increased confidence in patient safety reporting.
Topics: Patient safety, medical error, disclosing error.
