Academic journal article American Journal of Pharmaceutical Education

Evaluation of Interprofessional Team Disclosure of a Medical Error to a Simulated Patient

Academic journal article American Journal of Pharmaceutical Education

Evaluation of Interprofessional Team Disclosure of a Medical Error to a Simulated Patient

Article excerpt

INTRODUCTION

The American Association of Colleges of Pharmacy (AACP) and Accreditation Council for Pharmacy Education (ACPE) recognize the importance of quality improvement and patient safety as a core component of pharmacy education. (1,2) In addition, they evaluate the extent of interprofessional education at colleges and schools of pharmacy. (1,2) However, limited research is published regarding what pharmacists learn about medication safety in school, and there is considerable variation in the nature and depth of this subject within curricula. (3) Literature reports prevention and identification of errors as the main focus. (3-5) Rickles et al described a void in pharmacy education in providing students with information on how to communicate and disclose medical errors. (6) In their study, only a third of students knew how to communicate effectively. This study also demonstrated that in the control group, fewer students were able to appropriately communicate with patients about an error.

The majority of published research is with medical student/resident training. Stroud et al's review of the literature demonstrated that incorporating disclosure into curricula leads to improvement in learner knowledge, skills, and attitudes. (7) Most curricula consisted of a brief, single encounter, combining didactic lectures or small-group discussions with role-play. Inclusion of a brief curriculum about patient safety and medical errors with third-year medical students significantly increased awareness and improved communication skills. (8) In fact, 94% of students strongly agreed or agreed that this exercise was a useful learning experience. Sukalich et al's standardized patient encounter and self-guided tutorial to first-year medical residents proved to significantly improve self-efficacy of handling medication errors. They noted that this intervention could easily be replicated in other settings and with other members of the health care team. (9)

Although educators often focus on the recognition of medication errors, especially within laboratories and practice experiences, the literature contains less information about the communication of these errors when they do occur. (6) Good provider-patient communication skills facilitate trust and comfort, improve patient satisfaction, and minimize frequency of errors and potential litigation. (10-12) In fact, patients who are confident in their providers' commitment to disclose medical errors are not more litigious and far more forgiving than patients who have no faith in their providers' commitment to disclose. (13) Unfortunately, patients report that they are typically not given a clear explanation of what to do when an error occurs and often feel distanced from their health care provider(s) because of the lack of clear answers. (14,15) Patients want explicit answers about why the error happened, how the error's consequences will be mitigated, and how recurrences will be prevented. Many factors may contribute to a provider not fully disclosing an error including fear of litigation, damage to the clinician's reputation, potential job loss, and awkward clinical interactions. (14,15)

The purpose of this study was to evaluate the impact of an Interprofessional Communication Skills Workshop on students' confidence and proficiency in disclosing medical errors to patients. We believe the simulated interprofessional experience that includes a medication safety component aids in fulfilling accreditation standards set forth as above. The description of our process and evaluation, along with objective data from students in various professional programs, adds to the limited published literature in this area and may serve as a resource for other schools when developing their own experiences.

DESIGN

For two consecutive academic years, students from four different health professions (fourth-year medical students, third-year pharmacy students, second-year nursing students, and first-year physician assistant students) participated in team simulated interprofessional rounding experiences (SIRE). …

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