Interprofessional Education: Using Simulation to Teach Error Disclosure

The Institute of Medicine has reported staggering statistics of medical errors in hospitalized patients in the United States. Full disclosure of medical errors to patients is a new topic in the literature. Health professionals often fear disclosing errors to patients due to a myriad of legal, professional, and administrative constraints and consequences (Robinson & Hughes, 2008). While much of the error disclosure training literature focuses on medical students and physicians, (Barrios et al., 2009; Gilles, Speers, Young, & Fly, 2011; Gunderson, Smith, Mayer, McDonald, Centomani, 2009 ;) very little is reported on undergraduate and/or pre-licensure health professions training (Noland & Rickles, 2009; Thompson & Tilden, 2009). Currently, in the United States, health professions students are trained in “silos,” absent a team or collaborative approach. Recently, healthcare safety organizations have advocated for a focus on enhancing quality and patient safety education in pre-licensure health professions students (IOM, Health Professions Education: A bridge to quality, 2003). Six health professions organizations have described interprofessional core competencies to guide the development of learning experiences across health disciplines (Interprofessional Education Collaborative Expert Panel, 2011). Interprofessional education is defined by the World Health Organization (WHO) as “when students from two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes (2010).” Interprofessional education in the health professions is essential to building teamwork, enhancing communication among providers and patients, and ensuring patient safety (Brock et al., 2013). Widespread patient error in U.S. hospitals associated with substantial preventable mortality and morbidity, as well as major quality issues, has revealed the inadequacies in costly systems of healthcare delivery (IOM, 2000, 2003). Developing effective collaborative, health professional teams and redesigned systems is critical to achieving care that is patient-centered, safer, timelier, and more effective, efficient, and equitable (IOM, 2000; Reeves, Perrier, Goldman, Freeth & Zwarenstein, 2013). However, expecting health professionals to work together if they are not educated together proves challenging.

A collaboration of one university’s School of Dental Medicine, Nursing, and Pharmacy schools developed a one-day inter-professional simulation focusing on the disclosure of a healthcare error using theater students as standardized patients. Funding for this initiative was obtained through the SIUE Excellence in Undergraduate Education internal grants program.  Teams of eighty dental, nursing, and pharmacy students were formed from a convenience sample of students in the spring semester courses of each discipline. Students completed pre-test knowledge and attitude assessments, independently viewed a video and power point discussing error disclosure before the simulation experience. On the day of the simulation experience, health professional students were formed into interdisciplinary teams of four-five students. Ice-breaker exercises were conducted to familiarize the participants to one another’s roles and work to build a team mind-set. Each team was given the scenario describing the facts of a medical error with a hospitalized patient, adapted from the work of the University of Washington, Center for Health Science Inter-professional Education, Research and Practice and the Josiah Macy Foundation.  The teams were given instructions on how to approach the disclosure of a medical error with a patient. The teams were then placed in a simulation experience where the theater student took on the role of the injured patient’s family member. Unknown to the team was the response of the family member. University senior level theater students were trained to respond in three manners: a pleasant manner, a very upset and grief-stricken manner, and in an angry manner. Following the simulation experience, health team students were de-briefed regarding their responses to the patient’s family member, how well the team functioned, what they did well, and what they did poorly. The students completed another assessment of the knowledge and attitudes toward error disclosure. Lastly, the students completed a reflection of the simulation experience and their responses to the event.

The purpose of this poster presentation will be to demonstrate outcomes of interprofesssional education to teach medical error disclosure to prelicesure nursing, pharmacy and dental medicine students using a simulation experience. Demographic data describing the student's healthcare discipline will be collected. Instruments will be used to assess student knowledge and attitudes about error disclosure pre and post simulation. Pre and post mean scores on knowledge and attitudes towards error disclosure using a Likert scale will be compared with a T-test and MANOVA. Cronbach’s Alpha will be used to assess reliability of the instruments used in this study.  A thematic analysis will be conducted to determine themes revealed in student reflective writings. A sustainable model of interprofessional education will be recommended based on analysis of the barriers and facilitators of this project.