Error disclosure is universally recommended but incompletely implemented. Comparing disclosure skills among residents who completed experiential training to a historical cohort, this study found that current residents performed better. These results indicate that safety culture with respect to disclosure may be improving over time.

Disclosing medical errors to patients is essential for maintaining a therapeutic relationship and preventing further harm. This commentary describes a case in which a physician inadvertently used nonsterile instruments to perform procedures on two patients and presents options for what the physician might do next. Recommended best practices for error disclosure include being honest about what happened, explicitly stating that an error occurred, and explaining to the patient any relevant specific information that might be helpful in terms of necessary follow-up. The authors suggest that all errors be formally reviewed to prevent future harm and that health care systems should create an environment that facilitates error reporting.

A survey of academic medicine departments sought to identify quality improvement and patient safety activities in written promotion criteria. Investigators suggest language to use in promotion criteria that acknowledges quality and safety activities as core to clinical excellence, includes quality and safety as areas of scholarship, and delineates how the impact of these activities should be evaluated. The authors recommend that academic medical centers adopt such criteria across more institutions.

Based on a series of international expert meetings, this qualitative analysis identified key challenges in error disclosure: policy implementation, patient expectations, confidentiality and legal privilege, aligning disclosure with liability, and documenting and tracking disclosure. These barriers suggest that multiple actions are needed to bolster disclosure efforts. The authors advocate for collaboration between health systems and policymakers, enhanced patient and provider education to foster a blame-free safety culture, and establishment of standard metrics to document and benchmark disclosure across institutions. In a past AHRQ WebM&M perspective, Dr. Albert Wu discussed the importance of disclosing adverse events.

Physicians are notably loath to fully disclose their own errors, but some progress is being made in this area due to institutional policies supporting error disclosure. This article is intended to foster discussion of an especially thorny issue: how clinicians should approach error disclosure when the error was committed by a colleague. As little prior literature exists regarding this dilemma, the authors emphasize a patient-centered approach that begins with a respectful peer-to-peer conversation and does not shirk the need to fully disclose the error. The importance of institutional support, particularly in establishing a just culture that promotes error disclosure, is also emphasized. The article's lead author, Dr. Thomas Gallagher, was interviewed by AHRQ WebM&M in 2009.

This study used interviews with academic faculty—who had developed curricula in patient safety and quality improvement—to identify aspects of the cultural milieu that act as facilitators and barriers to embedding safety principles into medical training.

This commentary discusses recent findings about physicians who are the subject of recurrent complaints. It recommends proactively dealing with such doctors as a patient safety strategy.

When an error has occurred, many physicians choose their words carefully—failing to explicitly describe the error, acknowledge responsibility, or express sympathy to patients. This in part occurs because training in error disclosure is not a standard component of medical school or residency curricula. This review found that when implemented, error disclosure training generally resulted in improved knowledge and self-reported comfort with the disclosure process. However, few studies assessed whether training led to real-world behavior change. A difficult case of error disclosure is discussed in an AHRQ WebM&M commentary.

This review describes patient safety and quality improvement training in medical school and makes recommendations to address gaps in medical education.

This study revealed that nurses perceived their role in team-based error disclosure as secondary to balancing professional boundaries.

The majority of internal medicine department chairs supported development of career pathways in patient safety and quality improvement for academic faculty.

Students and residents chose their words carefully when describing how they would disclose medical errors to patients.

A recent report by the National Patient Safety Foundation called for medical schools and residency programs to reengineer their curricula to emphasize patient safety and quality improvement (QI) concepts. This systematic review evaluated the published literature on existing safety and QI curricula, and found that curricula were generally popular among trainees and resulted in increased knowledge of safety or QI concepts. Curricula focused on teaching systems analysis and continuous quality improvement principles, and some studies did find improvement in care processes associated with the educational intervention.

Patients desire and deserve disclosure of any errors that occur in their care, but fear of malpractice lawsuits is one of many factors that contribute to clinicians failing to disclose errors in a timely and transparent fashion. This survey compared how risk management professionals and physicians responded to simulated error scenarios. The researchers found that while risk managers were more likely to recommend full disclosure of both serious and less serious errors, physicians were more likely to offer an apology to the patient. Apologies may in fact be used as evidence in a malpractice lawsuit under certain circumstances—a 2008 review of "apology laws" found that while "expressions of sympathy" are generally protected from use as evidence, "admissions of fault" are admissible, even when such admissions include an apology. This fact may have influenced the risk managers' advice against apologizing. The tense relationship between error disclosure and malpractice liability is discussed in a PSNet perspective.

This article provides background on disclosure, what patients expect, and how policies can hamper or support efforts to implement disclosure programs.

This commentary describes strategies for disclosing medical errors at an institutional level.

This commentary accentuates the potential for faculty development in the quality improvement and patient safety arenas and describes how certain activities could merit academic recognition.

Most residents and medical students in this survey had witnessed a medical error, and a large proportion had disclosed an error to patients. However, few had received training in error disclosure.

This AHRQ-funded study surveyed more than 1000 physicians to understand their beliefs about error reporting and their use of current reporting systems. More than half the respondents reported involvement in a serious error with a similar proportion agreeing that system failures, rather than individual ones, are the cause. Most physicians did describe the use of formal reporting systems but felt they were largely inadequate mechanisms to both communicate and prevent errors. The authors conclude that physicians are in fact engaged in discussing errors but that current systems promote communicating these events through avenues that may not capture them at an institutional level, such as reporting them to a colleague. A past AHRQ WebM&M perspective discussed the experiences and success of the Minnesota adverse health events reporting system.

This article reviews the basis for disclosing medical errors, discusses what constitutes high-quality disclosure, and describes efforts in Canada to develop disclosure guidelines.