■大多数医疗保健提供者在其职业生涯中都会发生医疗错误。未来的医生必须接受有关错误披露的正式培训。
■我们为四年级医学生设计了基于形成技能的客观标准化临床考试(OSCE),以评估在所需的委托专业活动中披露错误的能力。教师观察了这次相遇,并完成了一份清单,评估了学生在沟通技巧和内容知识方面的表现。学生立即收到形成性反馈。然后,他们参加了一个便利的案例经验,讨论了披露的关键要素,利用角色扮演来加强技能,并反思自我护理实践。最后,学生完成了一项调查,评估他们对欧安组织对他们披露知识的影响的看法,技能,和态度。
■92名学生参加了欧安组织。其中,67(73%)完成了一项回顾性的前/后调查,评估了他们的披露知识,技能,和态度。41人(62%)没有发现错误。识别错误的学生(26,39%)比没有识别错误的学生更有可能使用两个患者的标识符,χ2(1)=13.3,p<.001。自我报告的舒适度和对披露的信心得到改善,自我护理实践也是如此(ps≤.005)。
■学生同意医疗保健提供者应该披露错误并知道如何这样做。在OSCE和结构化的汇报之后,学生自我报告的披露舒适度以及如何披露和如何报告错误的知识都得到了改善。欧安组织和基于案例的经验可以进行调整,以便在有关错误披露的课程中实施。
UNASSIGNED: Most health care providers will be involved in a medical error during their careers. It is critical that future physicians receive formal training on error disclosure.
UNASSIGNED: We designed a formative skills-based objective standardized clinical exam (OSCE) for fourth-year medical students to assess competence in disclosing an error during a required entrustable professional activity. Faculty observed the encounter and completed a checklist evaluating students\' performance in communication skills and content knowledge. Students received immediate formative feedback. They then participated in a facilitated case-based experience, discussed the critical elements of disclosure, utilized role-play to reinforce skills, and reflected on self-care practices. Finally, students completed a survey evaluating their perception of the OSCE\'s impact on their disclosure knowledge, skills, and attitudes.
UNASSIGNED: Ninety-two students participated in the OSCE. Of those, 67 (73%) completed a retrospective pre/post survey assessing their disclosure knowledge, skills, and attitudes. Forty-one (62%) did not identify the error. Students who identified the error (26, 39%) were more likely to use the two-patient identifier than students who did not identify the error, χ2(1) = 13.3, p < .001. Self-reported comfort and confidence in disclosure improved, as did self-care practices (ps ≤ .005).
UNASSIGNED: Students agreed that health care providers should disclose an error and know how to do so. Student self-reported comfort in disclosure and knowledge of how to disclose and how to report an error all improved following the OSCE and structured debrief. The OSCE and case-based experience can be adapted for implementation in curricula about error disclosure.