표준화 환자를 이용한 시뮬레이션에서 응급의학과 전공의의 실수 말하기 대화 내용 분석
Content analysis of error disclosure communication of emergency medicine residents in simulation using standardized patient
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Background : We analyze the contents of conversations of emergency medicine (EM) residents in a simulation using standardized patients in error disclosure education, and examine the characteristics of them. Methods : Error disclosure education program was conducted for 15 EM residents at a training hospital. One case of near miss and one case of adverse event were developed, and all 15 residents participated in each case. The contents of 30 error disclosure conversation were analyzed. Results : Residents talked more in ‘Acknowledge what happened’ and ‘Response/Plan for care’, and it was rare to have conversations of ‘Tell me about it’ or ‘Answer questions’ in both cases. The cause of the incident was explained frankly, but when the patient blamed there were some residents who told honestly or not. There was a tendency to vaguely reveal the subject who made the mistake or attribute it to another cause. Most of residents apologized to the patient. Most of residents explained systematic recurrence prevention measures and compensation plans, but there were cases where the contents were not specific or inaccurate. Throughout the entire phase, the expression “we” was often used. Conclusion : Residents had doctor-led conversations while error disclosure, so that they need more patient-centered conversations. When apology, empathy and regret should be conveyed in various expressions. Residents need to be properly trained and able to explain to patients about follow-up measures such as systematic recurrence prevention measures and compensation plans. These results can be a basic material for teaching error disclosure or guidelines.
Abstract
Background : We analyze the contents of conversations of emergency medicine (EM) residents in a simulation using standardized patients in error disclosure education, and examine the characteristics of them. Methods : Error disclosure education program was conducted for 15 EM residents at a training hospital. One case of near miss and one case of adverse event were developed, and all 15 residents participated in each case. The contents of 30 error disclosure conversation were analyzed. Results : Residents talked more in ‘Acknowledge what happened’ and ‘Response/Plan for care’, and it was rare to have conversations of ‘Tell me about it’ or ‘Answer questions’ in both cases. The cause of the incident was explained frankly, but when the patient blamed there were some residents who told honestly or not. There was a tendency to vaguely reveal the subject who made the mistake or attribute it to another cause. Most of residents apologized to the patient. Most of residents explained systematic recurrence prevention measures and compensation plans, but there were cases where the contents were not specific or inaccurate. Throughout the entire phase, the expression “we” was often used. Conclusion : Residents had doctor-led conversations while error disclosure, so that they need more patient-centered conversations. When apology, empathy and regret should be conveyed in various expressions. Residents need to be properly trained and able to explain to patients about follow-up measures such as systematic recurrence prevention measures and compensation plans. These results can be a basic material for teaching error disclosure or guidelines.
참고문헌 (23)
- McLennan S, "Regulating open disclosure : a German perspective", Int J Qual Health Care, 24(1), pp.23~27 (2012)
- "The Accreditation Council for Graduate Medical Education (ACGME)" (2015)[URL]
- "Announcement of training curriculum of medical residents" (2021)[URL]
- Bell SK, "Transparency when things go wrong : Physician attitudes about reporting medical errors to patients, peers, and institutions", J Patient Saf, 13(4), pp.243~248 (2017)
- Kachalia A, "Liability claims and costs before and after implementation of a medical error disclosure program", Ann Intern Med, 153(4), pp.213~221 (2010)
- Hatoun J, "Elucidating reasons for resident underutilization of electronic adverse event reporting", Am J Med Qual, 31(4), pp.308~314 (2016)
- Borz-Baba C, "Designing a curriculum for the disclosure of medical errors: A requirement for a positive patient safety culture", Cureus, 12(2), pp.e6931~ (2020)
- 이수현, "의료오류(Medical Error) 공개에 대한 의학전문대학원생과 인턴의 인식 및 태도 비교", Korean Journal of Medical Education, 24(3), pp.247~258 (2012), 한국의학교육학회[DOI]
- "Patient Safety Act" (2021)[URL]
- Ock M, "Perceptions of the general public and physicians regarding open disclosure in Korea : a qualitative study", BMC Med Ethics, 17(1), pp.50~ (2016)
- "Open disclosure handbook" (2014)[URL]
- Hsieh HF, "Three approaches to qualitative content analysis", Qualitative Health Research, 15(9), pp.1277~1288 (2005)
- Gardner AK, "A cross-specialty examination of resident error disclosure and communication skills using simulation", J Grad Med Educ, 10(4), pp.438~441 (2018)
- Shibatini M, "Passive and related constructions; A prototype analysis", Language, 61(4), pp.821~848 (1985)
- Choi D, "Singular use of Korean plural personal pronoun. Korean Cultural Studies", Institute of Korean Cultural Studies Yeungnam University, 42, pp.199~227 (2009)
- Branson CF, "Improving surgical residents’communication in disclosing complications : A qualitative analysis of simulated physician and patient surrogate conversations", Am J Surg, 215(2), pp.331~335 (2018)
- "Disclosing harm form healthcare delivery" (2017)[URL]
- Daigle E, "A federal standard for the protection of apologies following medical harm", Journal of Health Care Finance, 44(2) (2017)
- Chan DK, "How surgeons disclose medical errors to patients : a study using standardized patients", Surgery, 138(5), pp.851~858 (2005)
- Crimmins AC, "“To Err Is Human” but disclosure must be taught: A simulation-based assessment study", Simul Healthc, 13(2), pp.107~116 (2018)
- Leone D, "Error disclosure and family members’ reactions: does the type of error really matter?", Patient Educ Couns, 98(4), pp.446~452 (2015)
- Dahan S, "Apology in cases of medical error disclosure : Thoughts based on a preliminary study", PLoS One, 12(7), pp.e0181854~ (2017)
- Kaldjian LC, "Communication about medical errors", Patient Educ Couns (2020)