Disclosing Medical Error
OSCE
Faculty Instructions
Format: Residents will read the Medical Error Case and then role play a conversation
where they disclose this error to the patient (played by the faculty evaluator).
Evaluation: The evaluator completes the check off sheet of the desired behaviors and
attitudes the resident demonstrates during the disclosure conversation.
Faculty Role Play:
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You will play the role of the patient who has suffered the effects of
a medical error.
You were admitted to the hospital observation unit last night with
chest pain relieved by nitroglycerine in the Emergency
Department. Due to your risk factors and suggestive ST changes
you were placed on drip of unfractionated heparin.
At 5:00 am you were awoken by a brisk nosebleed which required
emergency nasal packing by an ENT consultant, and a blood
transfusion.
All of the hurried evaluations and treatments have occurred and the
blood transfusion is nearly complete, and all bleeding has stopped.
When the resident discloses the error to you initially respond with
a silent moment of disbelief, and then ask a lot of questions like:
o Why didn’t anybody notice my blood test last night?
o Does this kind of thing happen often in this hospital?
Allow the resident to respond to your questions and don’t get
openly hostile….a little anger can come through however.
Then ask the resident:
o Do you have any idea how it is have your nose packed and
feel like you can’t breath, and see your blood pouring out
of your face ?
Allow the resident to continue the conversation
Be sure to finally acknowledge that:
o I am not at all happy about this foul up/mess up/error , but
you are glad he(she) was honest with you and explained
why all of this happened.
Please do not embellish and threaten to sue !
It is OK to request a follow up meeting when your family can be
present
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OSCE Objective: Evaluate resident skill in the disclosure of medical error to patients.
Competency:
Interpersonal and Communication Skill
 Residents will be able to disclose medical error to patients in an honest and
compassionate manner
 Residents will be able to appropriately respond to patient questions, anger, and
emotions in a medical error disclosure conversation.
Competency:
Professionalism
 Residents will understand the ethical obligations of physicians to their patients
when a medical error occurs