Dataset Information

Characterizing Resident Preferences for Faculty Involvement and Support in Disclosing Medical Errors to Patients.

ABSTRACT:

Background?

Residents may be commonly involved with medical errors and need faculty support when disclosing these to patients.

Objective?

We characterized residents' preferences for faculty involvement and support during the error disclosure process.

Methods?

We surveyed residents from internal medicine, pediatrics, emergency medicine, general and orthopedic surgery, and obstetrics and gynecology residency programs at the University of Toronto in 2014-2015 about their preferences for faculty involvement across a variety of different error scenarios (ie, error type, severity, and proximity) and for elements of support they perceive to be most helpful during the disclosure process.

Results?

Over 90% of the 192 respondents (N = 538, response rate 36%) wanted direct involvement in the error disclosure process, irrespective of type or severity of the error. Residents were relatively comfortable disclosing prescription and communication errors without direct faculty involvement but preferred faculty involvement when disclosing diagnostic and management errors. When errors were severe, many residents still wanted to be involved but preferred having faculty lead the disclosure. Residents particularly wanted to participate in the process when they felt responsible for the error. Residents highly valued receiving faculty advice on how to manage consequences and how to prevent future errors in preparing for disclosure, as well as receiving postdisclosure feedback and personal support.

Conclusions?

Residents are willing participants in the error disclosure process and have specific preferences for faculty involvement and support. These findings can inform faculty development to ensure appropriate support and supervision for residents when disclosing errors to patients.

SUBMITTER: Singh N

PROVIDER: S-EPMC6108362 | biostudies-literature | 2018 Aug

REPOSITORIES: biostudies-literature

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Publications

Characterizing Resident Preferences for Faculty Involvement and Support in Disclosing Medical Errors to Patients.

Singh Narendra N Wong Brian M BM Stroud Lynfa L

Journal of graduate medical education 20180801 4

<h4>Background</h4>Residents may be commonly involved with medical errors and need faculty support when disclosing these to patients.<h4>Objective</h4>We characterized residents' preferences for faculty involvement and support during the error disclosure process.<h4>Methods</h4>We surveyed residents from internal medicine, pediatrics, emergency medicine, general and orthopedic surgery, and obstetrics and gynecology residency programs at the University of Toronto in 2014-2015 about their preferen ...[more]

PMID: 30154968

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Project description:PurposeDespite 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.MethodsFirstly, 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.ResultsOut 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.ConclusionThe 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.

Project description:BackgroundWhile concerns remain regarding Electronic Medical Records (EMR) use impeding doctor-patient communication, resident and faculty patient perspectives post-widespread EMR adoption remain largely unexplored.ObjectiveWe aimed to describe patient perspectives of outpatient resident and faculty EMR use and identify positive and negative EMR use examples to promote optimal utilization.DesignThis was a prospective mixed-methods study.ParticipantsInternal medicine faculty and resident patients at the University of Chicago's primary care clinic participated in the study.ApproachIn 2013, one year after EMR implementation, telephone interviews were conducted with patients using open-ended and Likert style questions to elicit positive and negative perceptions of EMR use by physicians. Interview transcripts were analyzed qualitatively to develop a coding classification. Satisfaction with physician EMR use was examined using bivariate statistics.ResultsIn total, 108 interviews were completed and analyzed. Two major themes were noted: (1) Clinical Functions of EMR and (2) Communication Functions of EMR; as well as six subthemes: (1a) Clinical Care (i.e., clinical efficiency), (1b) Documentation (i.e., proper record keeping and access), (1c) Information Access, (1d) Educational Resource, (2a) Patient Engagement and (2b) Physical Focus (i.e., body positioning). Overall, 85 % (979/1154) of patient perceptions of EMR use were positive, with the majority within the "Clinical Care" subtheme (n = 218). Of negative perceptions, 66 % (115/175) related to the "Communication Functions" theme, and the majority of those related to the "Physical Focus" subtheme (n = 71). The majority of patients (90 %, 95/106) were satisfied with physician EMR use: 59 % (63/107) reported the computer had a positive effect on their relationship and only 7 % (8/108) reported the EMR made it harder to talk with their doctors.ConclusionsDespite concerns regarding EMRs impeding doctor-patient communication, patients reported largely positive perceptions of the EMR with many patients reporting high levels of satisfaction. Future work should focus on improving doctors "physical focus" when using the EMR to redirect towards the patient.

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Project description:Background:Assessment of trainees' competency is challenging; the predictive power of traditional evaluations is debatable especially in regard to noncognitive traits. New assessments need to be sought to better understand affective areas like personality. Grit, defined as "perseverance and passion for long-term goals," can assess aspects of personality. Grit predicts educational attainment and burnout rates in other populations and is accurate with an informant report version. Self-assessments, while useful, have inherent limitations. Faculty's ability to accurately assess trainees' grit could prove helpful in identifying learner needs and avenues for further development. Objective:This study sought to determine the correlation between EM resident self-assessed and faculty-assessed Grit Scale (Grit-S) scores of that same resident. Methods:Subjects were PGY-1 to -4 EM residents and resident-selected faculty as part of a larger multicenter trial involving 10 EM residencies during 2017. The Grit-S Scale was administered to participating EM residents; an informant version was completed by their self-selected faculty. Correlation coefficients were computed to assess the relationship between residents' self-assessed and the residents' faculty-assessed Grit-S score. Results:A total of 281 of 303 residents completed the Grit-S, for a 93% response rate; 200 of 281 residents had at least one faculty-assessed Grit-S score. No correlation was found between residents' self-assessed and faculty-assessed Grit-S scores. There was a correlation between the two faculty-assessed Grit-S scores for the same resident. Conclusion:There was no correlation between resident and faculty-assessed Grit-S scores; additionally, faculty-assessed Grit-S scores of residents were higher. This corroborates the challenges faculty face at accurately assessing aspects of residents they supervise. While faculty and resident Grit-S scores did not show significant concordance, grit may still be a useful predictive personality trait that could help shape future training.

Project description:ImportanceWhile the relationship between resident work hours and patient safety has been extensively studied, little research has evaluated the role of attending physician supervision on patient safety.ObjectiveTo determine the effect of increased attending physician supervision on an inpatient resident general medical service on patient safety and educational outcomes.Design, setting, and participantsThis 9-month randomized clinical trial performed on an inpatient general medical service of a large academic medical center used a crossover design. Participants were clinical teaching attending physicians and residents in an internal medicine residency program.InterventionsTwenty-two faculty provided either (1) increased direct supervision in which attending physicians joined work rounds on previously admitted patients or (2) standard supervision in which attending physicians were available but did not join work rounds. Each faculty member participated in both arms in random order.Main outcomes and measuresThe primary safety outcome was rate of medical errors. Resident education was evaluated via a time-motion study to assess resident participation on rounds and via surveys to measure resident and attending physician educational ratings.ResultsOf the 22 attending physicians, 8 (36%) were women, with 15 (68%) having more than 5 years of experience. A total of 1259 patients (5772 patient-days) were included in the analysis. The medical error rate was not significantly different between standard vs increased supervision (107.6; 95% CI, 85.8-133.7 vs 91.1; 95% CI, 76.9-104.0 per 1000 patient-days; P = .21). Time-motion analysis of 161 work rounds found no difference in mean length of time spent discussing established patients in the 2 models (202; 95% CI, 192-212 vs 202; 95% CI, 189-215 minutes; P = .99). Interns spoke less when an attending physician joined rounds (64; 95% CI, 60-68 vs 55; 95% CI, 49-60 minutes; P = .008). In surveys, interns reported feeling less efficient (41 [55%] vs 68 [73%]; P = .02) and less autonomous (53 [72%] vs 86 [91%]; P = .001) with an attending physician present and residents felt less autonomous (11 [58%] vs 30 [97%]; P < .001). Conversely, attending physicians rated the quality of care higher when they participated on work rounds (20 [100%] vs 16 [80%]; P = .04).Conclusions and relevanceIncreased direct attending physician supervision did not significantly reduce the medical error rate. In designing morning work rounds, residency programs should reconsider their balance of patient safety, learning needs, and resident autonomy.Trial registrationClinicalTrials.gov Identifier: NCT03318198.

Dataset Information

Characterizing Resident Preferences for Faculty Involvement and Support in Disclosing Medical Errors to Patients.

Background?

Objective?

Methods?

Results?

Conclusions?

Publications

Characterizing Resident Preferences for Faculty Involvement and Support in Disclosing Medical Errors to Patients.

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