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Second Annual All Health Professions Error Disclosure Day a Great Success

For Immediate Release
Date: March 12, 2012
By: Ashley Wiggin, aaw4@uw.edu, 206-221-2456

IPE dayIPE dayOver 450 students from the University of Washington Schools of Medicine, Nursing and Pharmacy crowded into Hogness auditorium last Tuesday to hear nationally-recognized expert, Tom Gallagher, Associate Professor of Medicine and Medical History and Ethics, talk about how to disclose errors to patients as an interprofessional team. A slide showing an X-ray of a surgical instrument, inadvertently left in a patient’s abdomen following an operation, brought a collective groan to the audience. Gallagher explained the importance of conducting disclosures openly and honestly, helping patients and their families to understand the impact of errors, and discussing how similar errors will be prevented from happening to future patients.

“I have a lot of experience talking with patients about what has gone wrong,” said Gallagher, “and better interprofessional education about how to do this holds the key to better patient communication.”

That’s exactly what the All Health Professions Error Disclosure Day was designed to do.  Originally developed by a group of interprofessional faculty funded by grants from the Josiah Macy Jr. and Hearst Foundations, it brings together students from across the health sciences schools to practice disclosing errors as health care teams to patients and their families. When co-PIs, Brenda Zierler (Professor, School of Nursing) and Brian Ross (Professor of Anesthesiology, School of Medicine) began the grants in 2008, there were few opportunities for interactive, interprofessional learning for health sciences students.  Zierler, Ross and their team wanted to change that.  Sarah Shannon, School of Nursing Associate Professor, and Karen McDonough, School of Medicine Associate Professor, collaborated with others on the Josiah Macy Jr. grant team around the idea of developing interactive training for health sciences students using error disclosure as a topic for learning team communication skills. “The All Professions Error Disclosure Day has been a huge success,” said Zierler. “Staff and faculty work hard for many months scheduling this large event. The students really enjoy the chance to work together as a team.  They are inspirational to observe.”

The room buzzed with conversation when Gallagher asked participants to turn to their neighbor and pretend to disclose that they had just spilled their latte on their neighbor’s laptop. Students found the conversation difficult and were sometimes surprised by the reactions of their neighbor, which ranged from anger to requesting financial compensation for the damage.

“Learning to disclose errors as a team is a terrific way to learn how to work together effectively,” said Shannon. “Errors raise the ante for the health care team bringing up reactions of guilt and blame, grief and anger among the team and between the team and the patient and family.  Learning skills to approach error disclosure effectively can carry over to other team communication.  We make errors as a team; we need to disclosure errors as a team.  This truly is a team sport.” 

Following Gallagher’s presentation, students headed to breakout groups made up of 10-12 medical, pharmacy and nursing students.  A faculty member greeted each group and explained they would have a chance to disclose an error. The students were given a case of an error where their elderly patient was mistakenly given an antibiotic that he was allergic to.  The health care team missed the allergy alert.  Luckily, the patient was recovering from the mistake. The small groups discussed the error and then divided into three interprofessional teams to plan how they would disclose it to the patient’s family member (played by another faculty member waiting outside of the classroom). 

Playing the role of the daughter, School of Nursing lecturer Anne Kalkbrenner reacted to each team with a variety of emotions, from upset and unresponsive, to angry and frustrated.

IPE Day student groupIPE Day student groupIn one scenario, the family member entered the room angry and upset, demanding answers immediately from the patient-care team. “I felt put on the spot,” said one medical student, who took on the challenge of talking with the family member first. With little time to respond, the student noted that they didn’t have the opportunity to incorporate the rest of the patient care team into the conversation at the beginning.

“I should have found a way to better integrate my team into the conversation rather than taking on all the responsibility myself.”

The team was eventually able to help the family member understand the patient’s condition, the error, and provide her with information for how they would prevent the error from happening again.

“It was interesting to see her reaction to us,” said another student at the end of the interaction. “We didn’t really know what to expect when she walked in.”

Lisa Erlanger, School of Medicine Clinical Associate Professor who led the breakout group, noted that interprofessional education is a new way of training students, but one that is needed in health sciences education.

"When I went to medical school, we didn’t have any training like this,” she said. “I think this is a great chance for students to learn how to work together, because this is how we work together at the bedside.”

Zierler and HallZierler and HallError disclosure training isn’t just for students. New funding this year allowed for faculty from across the U.S. to come to the UW to learn how to implement interprofessional education, such as error disclosure training, in their own schools. More than 35 faculty members spent four days at the UW and at the Institute for Simulation and Interprofessional Studies at Harborview Medical Center to explore effective ways to develop faculty to be facilitators of interprofessional education and practice.  Leslie Hall, MD from the University of Missouri (Columbia) and Dr. Brenda Zierler were awarded a second Josiah Macy Jr. Foundation grant to support faculty training to lead interprofessional education and practice. Twenty-two faculty from the Universities of Virginia, North Dakota, Kentucky, Missouri School of Medicine, and Missouri-Kansas City at MU, Indiana University School of Medicine, Columbia University School of Nursing, and the Medical School of South Carolina joined five faculty from the Veteran’s Affairs Puget Sound Health Care System and eight UW faculty for the training last week.

“There is a national focus on training students to work together collaboratively to improve communication, but the training needs to start with faculty first,” said Zierler. “Faculty can model teamwork behaviors for students and they can create the opportunities to train health professional students together, focusing on communication, teamwork, collaborative care, values and ethics and role clarity.”

Photo captions: 

Top- Students listen in during error disclosure session with Dr. Tom Gallagher.

Middle- Students respond to concerns of a “family” member during error disclosure breakout groups.

Bottom- Brenda Zierler and Leslie Hall, Co-PIs of the faculty development grant that brought faculty to campus for IPE training.