Framing family conversation after early diagnosis of iatrogenic injury and incidental findings

Abstract

In general, trainees are ill prepared for delivering bad news. Disclosure of iatrogenic injuries was more challenging compared to that of incidental findings. Senior residents do better than junior residents at delivering bad news.

Teaching Medical Error Disclosure to Physicians-in-Training

“…14,15,21,22,28,29 Others taught it as part of a larger curriculum in either patient safety (8 studies, 42%) 12,13,16-20,24 or communication skills (2 studies, 11%), 23,30 or as part of simulation training (3 studies, 16%). [25][26][27] None of the published studies described training learners in error disclosure as part of a medical bioethics or professionalism curriculum. All programs delivered error disclosure training as a one-time encounter, with the total contact time ranging from as little as a single hour to a maximum of a dedicated half-day session.…”

“…23 These curricula included the importance of discussing the facts in an honest and transparent manner, a clear expression of regret and the role of apology, taking responsibility for the error, and describing the steps that will be taken to prevent future errors. 26,27,29 Some authors considered specific learner characteristics when deciding on the scenario or error type for their curriculum. Gillies and colleagues, 13 for example, used training-level-appropriate scenarios with good face validity for medical students (e.g., error resulting from a student's inaccurate reading and reporting of blood pressure).…”

“…A minority, primarily those initiatives within a larger communication skills curriculum, taught learners to use "breaking bad news" communication tools (e.g., SPIKES mnemonic) to structure their discussion of the error. 26 The remainder taught trainees a structured approach that included key elements of error disclosure. These elements were identified in the literature, taken from existing error disclosure toolkits, or, in one study, derived from primary research through patient interviews.…”

“…12 Eleven studies (58%) targeted medical students, 12-22 of which two also included interprofessional learners. 20,21 Nine studies (47%) targeted residents from a variety of training disciplines, [22][23][24][25][26][27][28][29][30] including general surgery (3 studies, 16%), 22,26,27 family medicine (2 studies, 11%), 23,24 internal medicine (2 studies, 11%), 22,23 obstetrics-gynecology (2 studies, 11%), 28,29 emergency medicine (1 study, 5%), 25 neurology (1 study, 5%), 30 and pediatrics (1 study, 5%). 25…”

Development and Evaluation of a Program to Strengthen First Year Residents’ Proficiency in Leading End-of-Life Discussions

“…17 The content of the SPIKES protocol was found to be practical and easy to use by 99% of surveyed oncologists. 17 Many existing studies have used the SPIKES protocol to teach communication skills to both medical students and residents 10,14,16,24 across multiple medical specialties including surgery, 16,25 neurology, 26 and optometry. 27 The purpose of the present study was to develop and evaluate a program to enhance physicians' end-of-life communication with families of dying patients using the SPIKES protocol in a format that could be easily incorporated into an existing curriculum for first year internal medicine residents.…”