Are interpersonal communication skills adequately taught at postgraduate specialist level in South Africa? The neurology experience

Disclosing medical errors: how do we prepare our students?

PURPOSE

Despite patient safety initiatives, medical errors remain common and devastating. Disclosing errors is not only ethical, but also promotes restoration of the doctor-patient relationship. However, studies show active avoidance of error disclosure and the need for explicit training. In the South African setting, sparse information exists in terms of undergraduate medical training in error disclosure. To address this knowledge gap, the training of error disclosure in an undergraduate medical programme was examined, against the background of the available literature. The objective was to formulate a strategy to improve error disclosure teaching and practice, with the goal of improving patient care.

METHODS

Firstly, the literature was reviewed regarding the training of medical error disclosure. Secondly, the undergraduate medical training in error disclosure was probed, by looking at the pertinent findings from a broader study on undergraduate communication skills training. The design of the study was descriptive and cross-sectional. Anonymous questionnaires were distributed to all fourth- and fifth-year undergraduate medical students. Data were predominantly analysed quantitatively. Open-ended questions were analysed qualitatively using grounded theory coding.

RESULTS

Out of 132 fifth-year medical students, 106 participated (response rate 80.3%), while 65 out of 120 fourth-year students participated (response rate 54.2%). Of these participants, 48 fourth-year students (73.9%) and 64 fifth-year students (60.4%) reported infrequent teaching in the disclosure of medical errors. Almost half of the fourth-year students (49.2%) considered themselves novices in error disclosure, while 53.3% of fifth-year students rated their ability as average. According to 37/63 (58.7%) fourth-year students and 51/100 (51.0%) fifth-year students, senior doctors seldom or never modelled patient-centred care in the clinical training setting. These results resonated with the findings of other studies that showed lack of patient-centredness, as well as insufficient training in error disclosure, with resultant low confidence in this skill.

CONCLUSION

The study findings confirmed a dire need for more frequent experiential training in the disclosure of medical errors, in undergraduate medical education. Medical educators should view errors as learning opportunities to improve patient care and model error disclosure in the clinical learning environment.

Exploring possibilities of harmonising social justice with medical education through the use of CanMeds and AfriMeds when engaging in discipline integration

Medical curricula are largely content heavy and grossly overloaded but focus primarily on medical and biomedical sciences. It has been argued by authors such as Gukas and Filies that well-balanced professionals are seldom produced by such content heavy curricula. The incorporation of social justice principles in medical curricula is vital in promoting the production of well-balanced and competent healthcare professionals, as called for in the CanMeds/AfriMeds frameworks. However, the World Federation for Medical Education issued a consensus statement asserting that medical students in the USA and Canada receive little to no formal training and teachings as far as social justice is concerned. In this paper it is asserted that medical students in South Africa are no exception to such consensus.  It is further asserted in this paper that if one begins to examine principles of CanMeds/AfriMeds, entry points for the insertion of social justice principles becomes a possibility without having to further overload an overloaded curriculum. In essence, adopting and promoting roles of CanMeds/AfriMeds such as professional, collaborator and scholar enhance a non-hierarchical style and environment of teaching medical students. This new style and environment of learning are shown in this paper to enable an insertion of social justice principles in a medical curriculum in instances where such insertion may otherwise have been impossible.