1. Join the conversation! Our Twitter hashtag is MSE12 Join the conversation. Our Twitter hashtag is #MSE12 Teaching Communication Skills Through Disclosure of a Medical Error Ellen Miller, MD: Sudhir Vaidya, MD New York Medical College of the Valhalla NY

2. Join the conversation. Our Twitter hashtag is #MSE12 Objectives To understand why “Medical Error and Patient Safety” continues to be an important topic in medical education Overview of the medical error curriculum at the New York Medical College Compare with the curriculum at a few other institutions Have an interactive discussion on medical error curriculum development

3. Join the conversation. Our Twitter hashtag is #MSE12 Medical Errors and Patient Safety There has been an exponential growth in literature on medical errors and patient safety since 1990s through the first decade in 21 st century Agency for Healthcare Research and Quality (AHRQ) Research Activities bulletin has a regular topic on Patient Safety and Quality in every issue

4. Join the conversation. Our Twitter hashtag is #MSE12 Medical Error/Patient Safety Medical Literature: Reviewed By Dr. J. Halbach Medical Literature New York Medical College Department of Family Medicine Articles on Medical Error/Patient Safety in Refereed Journals by year of publication (as of 4/15/02).

5. Join the conversation. Our Twitter hashtag is #MSE12 Literature on patient safety medical education 4 in 2003 3 in 2004 3 in 2005 6 in 2006 5 in 2007 6 in 2008 9 in 2009 6 in 2010

6. Join the conversation. Our Twitter hashtag is #MSE12 Patient safety education for undergraduate medical students: a systematic review Yanlie Nie, Lin Li et.al BMC Medical Education 2011, 11:33 Conclusion: There are only a few relevant published studies on the inclusion of patient safety into the undergraduate curriculum in medical schools either as a selective course, a lecture program, or being integrated into existing curriculum even in developed countries with advanced health and education systems. The integration of patient safety education into the existing curriculum in medical schools internationally provides a significant challenge.

7. Join the conversation. Our Twitter hashtag is #MSE12 Wong et-al Medical Education 2012: 46 107-119 Quality improvement in medical education: current state and future directions: Recommendations Firstly, a major effort to build faculty capacity, especially among teachers of QI, is needed. Secondly, accreditation standards and assessment methods, both in-training and at end-of-training certification examinations, must explicitly target these competencies. Finally, and perhaps most importantly, we need to refocus our attention at all levels of training and to instill fundamental collaborative, open-minded behaviors so that future clinicians are primed to promote a culture of safer, higher-quality care.

8. Join the conversation. Our Twitter hashtag is #MSE12 WHO Patient Safety Curriculum Guide for Medical Schools: Recommended Topics What is patient safety? Harm due to medical treatment due to complexity of medical care. What is human factor and why it is important? Understanding why humans miscommunicate? How can processes be simplified and standardized. What is the back-up if system fails? Understanding systems

9. Join the conversation. Our Twitter hashtag is #MSE12 WHO Patient Safety Curriculum Guide for Medical Schools: Recommended Topics-2 Being an effective team player Understanding and learning from errors Understanding and managing clinical risk: understanding the difference between blame and systems approaches. Understanding and managing risk- Clinical risk management strategies

10. Join the conversation. Our Twitter hashtag is #MSE12 WHO Patient Safety Curriculum Guide for Medical Schools: Recommended Topics-3 Introduction to performance improvement methods Engaging with patients and caregivers Minimizing infection through improved infection control Patient safety and invasive procedures Improving medications prescription writing

11. Join the conversation. Our Twitter hashtag is #MSE12 NYMC Medical Error and Patient Safety Curriculum: Background Information In year 2000 Curriculum at the New York Medical College for medical students during the third year Family Medicine Clerkship was designed, which consisted of A lecture on Medical Errors and Patient Safety on “Orientation Day” Video taping sessions with discussion on error disclosure

12. Join the conversation. Our Twitter hashtag is #MSE12 Medical Error Disclosure Training at NYMC Initial Results Teaching Medical Students About Medical Errors and Patient Safety: Evaluation of a required Curriculum Halbach, Joseph L MD MPH: Sullivan Laurie L Ph.D CSW Academic Medicine June 2005-Volume 80-Issue 6 pp 600-606 Conclusion: Findings suggested that awareness about patient safety and medical error can be increased and sustained through the use of an experiential curriculum, and students rated this as a valuable experience.

13. Join the conversation. Our Twitter hashtag is #MSE12 Orientation day interactive session Discussion on Medical Errors and Patient Safety Prevalence of medical error and harms Definition of medical error and adverse event Case discussion one or two real events brought up by students Issues influencing “Medical Error” reporting Changes in values: a.humility, b.discipline, c.teamwork, d. systems approach Changes in culture: a. naming, blaming, and shaming, b. conspiracy of silence, c. hierarchy Institutional approaches to minimize errors

14. Join the conversation. Our Twitter hashtag is #MSE12 Discussion on how to handle medical errors Acknowledge your mistake Discuss situation with a colleague, superior, and/or friend Think “system’s approach” to prevent errors Seek professional advice if needed for your own support Review your successful accomplishments Don’t forget basic self care Apologize to superiors and patient

15. Join the conversation. Our Twitter hashtag is #MSE12 Discussion on Medical Errors Disclosure Medico-legal aspects Art of apology Role play What phrases to use What not to say Other communication considerations: Avoid medical jargon; Be aware of cultural/language barriers; Speak slowly; Be aware of body language; Don’t overwhelm with information; Don’t oversimplify either; Allow time for questions; Don’t monopolize the conversation

16. Join the conversation. Our Twitter hashtag is #MSE12 Role Play Session Trained standardized patients Videotaping equipment Each students get a chance to role play Discussion of videos are include students, actors and faculty Students evaluation of the program

17. Join the conversation. Our Twitter hashtag is #MSE12

18. Q1: Instructions were clear. Q2: The "patient" was realistic. Q3: There was sufficient time to attend to the medical error during the interview. Q4: The opportunity to present an error to a patient increases my confidence about discussing this issue with patients. Q5: The orientation to medical errors, during the first day of the clerkship, provided a good introduction to the issue. Q6: The readings provided on this issue were helpful. Evaluation of the instructions, orientation lecture and organization

19. Join the conversation. Our Twitter hashtag is #MSE12 Evaluation of the instructions, orientation lecture and organization

20. Join the conversation. Our Twitter hashtag is #MSE12 Evaluation of the feedback from the standardized patient Q7: Was consistent with MY OWN assessment of my performance. Q8: Was constructive. Q9: Helped me to identify areas that I need to improve.

21. Join the conversation. Our Twitter hashtag is #MSE12 Evaluation of the feedback from the standardized patient

22. Join the conversation. Our Twitter hashtag is #MSE12 Evaluation of the feedback from the preceptor Evaluation 10: Was consistent with MY OWN assessment of my performance. Evaluation 11: Was constructive. Evaluation 12: Helped me to identify areas that I need to improve. Evaluation 13: Overall, the standardized patient exercise was a valuable LEARNING experience.

23. Join the conversation. Our Twitter hashtag is #MSE12 Evaluation of the feedback from the preceptor

24. Join the conversation. Our Twitter hashtag is #MSE12

27. Superimposed graphs

28. Join the conversation. Our Twitter hashtag is #MSE12 Cost of the program Grant of $ 500,000 for initial set-up training actors and preceptors 0.2 FTE of coordinating faculty and one support staff Weekly 4 hours session by one preceptor and two standardized patients Other ancillary services.

29. Join the conversation. Our Twitter hashtag is #MSE12 Conclusions The program continues to be positively evaluated Over time, evaluations of the program show even more positive trend Whether increasing positive trend is due to increased awareness of the importance of the subject or improvement of mentors skills needs to be determined

30. Join the conversation. Our Twitter hashtag is #MSE12 Other approaches to training Example 1 Teaching Medical Error Apologies: Development of a Multi- component Intervention Ralph A Gillies, PhD: Stacie H. Speers, MS: Sara E. Young, MD: Christopher A. Fly MD Family Medicine June 2011 Vol 43 NO 6 400-406 First-year medical students taking a professionalism course Increasingly applied tasks from computerized tasks to writing of an apology, small group discussion and simulated patient encounter. Results- Yielded positive changes in students perception of the importance of offering effective apologies, confidence in doing so, as well as their comfort in disclosing errors to a patient or faculty member

31. Join the conversation. Our Twitter hashtag is #MSE12 Other approaches to training Example 2 Design: A 5-h evidence-based module on understanding error in healthcare was designed with a preliminary evaluation using self-report questionnaires. Setting: A UK medical school. Participants: 110 final year students. Conclusions: Before attending the module, the students reported they had little understanding of patient safety matters. One year later, only knowledge and the perceived personal control over safety had improved. The students rated the teaching process highly and found the module valuable. Longitudinal follow-up is required to provide more information on the lasting impact of the module.

32. Join the conversation. Our Twitter hashtag is #MSE12 Approach to training Web based. Small group discussions Didactic Specific Projects Combinations

33. Join the conversation. Our Twitter hashtag is #MSE12 Discussion Is combination of a didactic and experiential training an optimal combination? How to compare cost effectiveness? Should STFM with help of WHO and other international organizations develop a “Global Curriculum” based on WHO recommendations, on patient safety and medical error training and have a program of training the trainers? Sample video tape of a student disclosure session