Measuring the Uptake of Disclosure and Apology Content in the American Medical School Curriculum.

Surveys were sent to deans and curriculum leaders of American medical schools regarding the teaching of disclosure and apology in the curriculum. One-hundred six medical schools responded (n = 106; 60% response rate) and results showed that disclosure and apology (also known as communication and resolution programs or CANDOR) is being taught in American medical schools but more work remains to develop consistent curriculum across all medical schools. The same survey (with slightly different wording) was sent to a commercial list of fourth year medical students; two hundred thirty students (n = 230, 17% response rate) representing 67 medical schools completed the survey. The students' data - though not statistically significant - provides a glimpse into students' feeling about this topic, including the desire to learn what happens after "sorry" and how cases can be resolved with disclosure, including the insurance, legal, and compensation aspects. Further avenues of research on this topic are suggested.

Review of disclosure and apology literature: Gaps and needs.

A review of the literature related to the disclosure movement was conducted to find gaps and needs while identifying areas where needs are being met. There are several articles that address claims and other economic factors. Moreover, there are many papers that define barriers to disclosure with suggested workarounds. There is also a wealth of training content that teaches how to say "sorry." However, gaps and needs were identified. The "gap list" was developed with a focus on concepts that are novel or not mentioned in the literature as well as issues in the disclosure movement that would benefit from greater attention: (1) lack of research and disclosure training content for health care professionals beyond acute care; (2) messaging and disclosure programs, including the meaning of "apology"; (3) insufficient integration between disclosure programs and second victim support programs; (4) confidentiality clauses; (5) the National Practitioner Data Bank and state licensure boards being viewed as an impediment to disclosure; (6) understanding awareness of the disclosure movement by consumers, personal injury bar, and payors; (7) measuring what medical and nursing schools are teaching about disclosure; and (8) encouraging states to pass apology laws that support the development of disclosure programs.

Apology and disclosure for physicians and medical practices: what to keep in mind.

Disclosure and apology is an important issue in healthcare, yet physicians and other healthcare professionals are still struggling to conceptualize this topic. This article will discuss how physicians and medical practices should approach disclosure with their hospital system and/or insurance company, and how they can empathize and stay connected with their patient post-event regardless of insurance coverage.

The Sorry Works! Coalition: making the case for full disclosure.

BACKGROUND: The Sorry Works! Coalition, an organization of doctors, lawyers, insurers, and patient advocates, is dedicated to promoting full disclosure and apologies for medical errors as a "middle-ground solution" in the medical liability crisis. If a standard of care was not met (as shown by a root cause analysis) in a bad outcome or adverse event, the providers (and their insurer) should apologize to the patient/family, admit fault, provide an explanation of what happened and how the hospital will ensure that the error is not repeated, and offer compensation. The Sorry Works! protocol is based on the disclosure program developed at the Department of Veterans Affairs Hospital in Lexington, Kentucky. GOALS: The coalition's goals are to (1) educate all stakeholders in the medical liability debate, (2) serve as an organizing force for the full-disclosure movement, and (3) advocate for legislative incentives, including pilot programs. OVERCOMING CULTURAL AND LEGAL OBSTACLES: In large part, the coalition's educational efforts are intended to overcome cultural and legal barriers to full disclosure, which often represent emotional, knee-jerk responses within the medical, insurance, and legal communities. Perhaps the greatest hurdle of all is the culture of the medical profession; considerable changes are needed if doctors are to enjoy the benefits of Sorry Works! and other full-disclosure programs. CONCLUSION: Sorry Works! entails changing the culture of medicine, medical risk management, and the associated insurance and legal support structure.