Teaching medical students the art of medical error full disclosure: evaluation of a new curriculum.

BACKGROUND: Despite the acknowledgment that error disclosure is essential to patient safety and the patient-provider relationship, there is little undergraduate training related to error disclosure. DESCRIPTION: Pilot test and evaluate an educational module designed to improve student confidence in understanding and performing medical error disclosure. The training was designed to establish competency in the four Rs of apology-recognition, responsibility, regret, and remedy-and included a 3-hr interactive discussion, training DVDs, practice of full disclosure using standardized patients, and facilitated reflection. Students were assessed pre and post using a self-administered confidence survey. EVALUATIONS: Confidence among students improved significantly from 11.5 +/- 2.9 before to 15.3 +/- 1.3 after the module (p <.0001). CONCLUSIONS: The full disclosure educational module significantly improved students' perceived confidence in admitting medical errors and their confidence in understanding and performing the full disclosure of a medical error.

To IRB or not to IRB?

Improving medical practice begins with the improvement of medical education. In this process, most academic medical faculty assume the dual roles of both teacher and researcher, often without intending to or realizing that they are. With the increased tightening of regulation and supervision of biomedical research in the United States, academic medical institutions and their individual faculty face the daunting regulatory compliance problems that are traditionally associated with clinical and bench research projects. In 2000, as part of a new geriatrics curriculum initiative, one medical school (not the authors' present institution) developed a mentor program that was designed to positively influence students' attitudes about aging. Despite the attempts of faculty to design the curriculum and evaluation process to conform to human subjects regulations, formal allegations of research misconduct were brought against the faculty who were in charge of the curriculum. Even though research that shows that 70% of alleged research misconduct charges result in exoneration, an accusation of misconduct can have serious consequences for faculty including suspension of their project, undergoing an intensive investigation, and potentially making it impossible for the faculty member or institution to apply for future federally supported research funds. The authors wrote this article to serve as a wake-up call for medical educators to become intimately familiar with their own institution's institutional review board process and be proactive in educating themselves and their peers regarding research in medical education.

Dynamic health promotion for the geriatric population.

The documents Healthy People 2000 and its update, Healthy People 2010, have helped focus national attention on the neglected areas of disease prevention and health promotion and maintenance. Despite increasing awareness and the proliferation of research that demonstrates the effectiveness of a healthy lifestyle for disease prevention, patients and healthcare professionals continue to struggle with an effective approach to effecting healthy lifestyle strategies. The inclusion of health promotion goals into care plans seldom is enough to create positive behavioral changes in a patient. Understanding what motivates an older individual to adopt healthy habits and what behavioral change process the individual must take to be successful is a key starting point for the rehabilitation nurse dedicated to the promotion of health and wellness. The transtheoretical model of change (TTM) is an approach that can be used to create an atmosphere for the adoption of healthy lifestyle practices, and assist in the behavioral change process necessary to promote older adults' success in this endeavor.