Being a GI Fellow Means Never Having to Say Youʼre Sorry? Assessing Skills in Disclosing Medical Errors: 1420

Purpose: There is evidence that disclosing medical errors and offering apologies enhances patient safety, fulfills an ethical commitment to honesty and accountability, and reduces the number and cost of malpractice claims. An observed structured clinical examination (OSCE) was developed to assess the competency of GI fellows in these areas with the hope of informing policy and curriculums. Methods: Using validated OSCE checklists, we revised 3 cases previously described (breaking bad news, apologizing for a complication, and obtaining informed consent) to add a specific focus on cultural competency. In the apology case, a 50-year-old male undergoes a colonoscopy, subsequently complicated by a perforation. The goals for the GI fellows were to explain that a medical error was made, regain the patient's trust, and convince the patient to stay for follow-up care. Four faculty members from 2 GI training programs in NYC observed the 4 station OSCE and 11 fellows participated. Immediately following each case, feedback was provided by the faculty observer and the standardized patient. Data were collected to specifically assess the fellows' performance. All 4 OSCE stations were videotaped and observed live by faculty. Post OSCE, we held a debriefing session to discuss the role of cultural competency in offering apologies. Results: We found that only 36% of participants (4/11 fellows) personally apologized for the complication and took responsibility for the situation. Moreover, 73% of participants (8/11 fellows) failed to reassure the patient that the quality of care was appropriately supervised and executed. Underlying this failure, only 9.1% of participants (1/11 fellows) recognized that the standardized patient harbored a mistrust of the medical care system. Conclusion: OSCEs provide a formalized tool to assess the ability of physicians in offering apologies for medical errors and recognizing their role in establishing trust and continuing care. The failure of a majority of participants to apologize personally for the complication and take responsibility for the situation suggests that formal training programs may not adequately prepare future caregivers to know when and how best to take responsibility and offer apologies for medical errors. More study is needed to assess the prevalence of this deficiency and its underlying causes.