Medical Error Disclosure & Peer Support

Much attention has focused on improving the safety of health care and reducing errors, but less attention has been given to helping physicians, other healthcare team members, and patients and families deal with the aftermath when a medical error and/or untoward outcome does occur.

Medical errors are a nearly universal experience for physicians and one of the most difficult professional experiences they face. Yet, multiple studies have shown that training in handling the aftermath of a medical error is not universal.

Health care providers need education and mentoring to assist them in working through these difficult discussions with openness and compassion. They also need support in working through their own emotions and responses. Based on the findings of the UVA Wisdom in Medicine study(1) and work at other centers(2,3), we have developed a program to address these needs.

Begun in 2013, the University of Virginia offers a program to train physicians, nurses, chaplains, FEAP counselors and other healthcare professionals as disclosure coaches and peer supporters. This three-session, 7.5 hour program uses participant role plays and paired interviews to address these themes:

• Elements of an ideal disclosure conversation including the ask-tell-ask methodology, the power of the words “I am sorry”, and avoidance of common pitfalls
• Strategies to mitigate negative effects and enhance positive, growth-enhancing effects of the emotions associated with medical error
• Recognizing the stages of recovery from medical error
• Helpful and unhelpful approaches to peer support and awareness of resources for extended support when indicated
• The role of writing and reflection in recovery and the gaining of wisdom
• Medicolegal and ethical issues

At this time, the program is open to UVA affiliates only; however, we hope to expand the program to external participants in the future. For more information about our program, please contact us at iqpsadmin@virginia.edu.

1. Plews-Ogan M, May N, Owens J, Ardelt M, Shapiro J, Bell SK. Wisdom in medicine: what helps physicians after a medical error. Acad Med. 2015 Sep 4. [Epub ahead of print]
2. Plews-Ogan M, Owens J, May N. Wisdom through adversity: growing and learning in the wake of an error. Patient Educ Counseling. 2012;88:449-454.
3. Bell S, Moorman D, Delbanco T. Improving the patient family and clinician experience after harmful events: the “when things go wrong” curriculum. Acad Med. 2010;85:1010-1016.
4. Scott SD, Hirschinger LE, Cox KR, et al. The natural history of recovery for the healthcare provider “second victim” after adverse patient events. Qual Saf Health Care. 2009;18:325-330.