Medical error professionals' perspectives on Inter-system Medical Error Discovery (IMED): Consensus, divergence, and uncertainty

How to HEEAL: A Patient and Peer-Centric Simulation Curriculum for Medical Error Disclosure

Introduction

Medical errors are an unfortunate certainty with emotional and psychological consequences for patients and health care providers. No standardized medical curriculum on how to disclose medical errors to patients or peers exists. The novel HEEAL (honesty/empathy/education/apology-awareness/lessen chance for future errors) curriculum addresses this gap in medical education through a multimodality workshop.

Methods

This 6-hour, two-part curriculum incorporated didactic and standardized patient (SP) simulation education with rapid cycle deliberate practice (RCDP). The morning focused on provider-patient error disclosure; the afternoon applied the same principles to provider-provider (peer) discussion. Summative simulations with SPs evaluated learners' skill baseline and improvement. Formative simulations run by expert simulation educators used RCDP to provide real-time feedback and opportunities for adjustment. Medical knowledge was measured through pre- and postintervention multiple-choice questions. Learners' confidence and attitude towards medical errors disclosure were surveyed pre- and postintervention with assistance of the Barriers to Error Disclosure Assessment tool, revised with the addition of several questions related to provider-provider disclosure.

Results

Fourteen medical students participated in this pilot curriculum. Statistical significance was demonstrated in medical knowledge (p = .01), peer-disclosure skills (p = .001), and confidence in medical error disclosure (p < .001). Although there was improvement in patient-disclosure skills, this did not reach statistical significance (p = .05).

Discussion

This curriculum addresses the need for designated training in medical error disclosure. Learners gained knowledge, skills, and confidence in medical error disclosure. We recommend this curriculum for medical students preparing for transition to residency.

Nonsurgical Treatment of Carpal Tunnel Syndrome: A Survey of Hand Surgeons

Background

The nonsurgical treatment of carpal tunnel syndrome (CTS) consists of multiple modalities: splinting, corticosteroid injections, hand therapy, and oral medications. However, data supporting the effectiveness of these different modalities are varied, thus creating controversy regarding the optimal nonsurgical treatment. It is unknown how current hand surgeons utilize nonsurgical treatments for CTS.

Methods

An anonymous web-based survey was sent to 3289 members of the American Society for Surgery of the Hand to assess nonsurgical treatment patterns for CTS. We pretested the survey using expert survey and content review and cognitively tested the survey for readability and understandability.

Results

We analyzed surveys from 770 hand surgeons. Of the respondents, 41.2% of respondents recommend steroid injections for the treatment of CTS, 81.3% of respondents do not believe that oral steroids are beneficial for the treatment of CTS, and 3.6% of respondents typically prescribe gabapentinoids for the treatment of CTS. In total, 561 (72.9%) respondents always, usually, or sometimes encounter patients with more than two steroid injections for CTS before hand surgeon evaluation.

Conclusions

There is variation in the use of nonsurgical modalities for the treatment of CTS among American Society for Surgery of the Hand members. However, patients do not obtain long-term benefit from multiple steroid injections and gabapentinoids for the treatment of CTS, highlighting the importance of dissemination of evidence-based nonsurgical management of CTS. Collectively, these findings underscore the importance of providing clear guidelines as to which patients benefit most from nonsurgical treatments.