표준화 환자를 이용한 시뮬레이션에서 응급의학과 전공의의 실수 말하기 대화 내용 분석

Abstract

Background : We analyze the contents of conversations of emergency medicine (EM) residents in a simulation using standardized patients in error disclosure education, and examine the characteristics of them. Methods : Error disclosure education program was conducted for 15 EM residents at a training hospital. One case of near miss and one case of adverse event were developed, and all 15 residents participated in each case. The contents of 30 error disclosure conversation were analyzed. Results : Residents talked more in ‘Acknowledge what happened’ and ‘Response/Plan for care’, and it was rare to have conversations of ‘Tell me about it’ or ‘Answer questions’ in both cases. The cause of the incident was explained frankly, but when the patient blamed there were some residents who told honestly or not. There was a tendency to vaguely reveal the subject who made the mistake or attribute it to another cause. Most of residents apologized to the patient. Most of residents explained systematic recurrence prevention measures and compensation plans, but there were cases where the contents were not specific or inaccurate. Throughout the entire phase, the expression “we” was often used. Conclusion : Residents had doctor-led conversations while error disclosure, so that they need more patient-centered conversations. When apology, empathy and regret should be conveyed in various expressions. Residents need to be properly trained and able to explain to patients about follow-up measures such as systematic recurrence prevention measures and compensation plans. These results can be a basic material for teaching error disclosure or guidelines.