MedEdPORTAL (Mar 2015)
Interprofessional Collaborative Incident Response Training (I-CIRT)
Abstract
Abstract Introduction Critical incidents such as medical errors and unanticipated patient deaths are an unfortunate but inevitable part of the practice of medicine. The seminal “To Err is Human” report by the Institute of Medicine in 1999 indicated that as many as 98,000 patient deaths may be attributable to medical errors each year. Previous studies have suggested that while physicians desire to have stronger skills for communicating critical events to patients, this type of training is historically lacking. The development of effective communication behaviors requires a combination of practice, observation, and feedback. Standardized patients (SPs) have been used in this type of training with good effect. Prior studies have shown that SP training is associated with greater physician confidence and completeness in error disclosure. Methods The Interprofessional Collaborative Incident Response Training (I-CIRT) is a workshop intended to give clinician trainees an opportunity to learn and practice essential skills for communicating critical incidents (e.g., medical errors, unanticipated death) to patients and their families in an honest, compassionate, and collaborative manner. This 4-hour workshop involves formal didactics, peer-to-peer role-play and feedback, an SP encounter, and a documentation exercise. It is intended to be a team-based experience that is broadly applicable to different provider types and levels of training and experience. Results We held I-CIRT training for the emergency medicine residents in our hospital. We held sessions on three separate dates, which were attended by between four and 18 residents per session. The participants rated the effectiveness of the training using a 5-point Likert-Style scale. With regards to the overall educational experience, average ratings to the following questions (n = 26) were as follows: “This session improved my confidence that I can respectfully communicate a critical incident to a patient/family” (M = 4.38, range = 2-5); “I can apply the content of the communication presentation to my practice” (M = 4.78, range = 4-5); and “I understand the importance of consistent communication in situations where unexpected outcomes or errors may have occurred” (M = 4.92, range = 4-5). With regards to the SP experience, participants rated the effectiveness of the simulation again using a 5-point Likert-style scale. Average responses (n = 30) were as follows: “The presimulation teaching activity sufficiently prepared me to respectfully communicate a critical incident to a patient/family” (M = 4.22, range = 4-5); “The scenario was appropriately challenging” (M = 4.44, range = 2-5); and “The scenario prompted realistic responses from me” (M = 4.67, range = 3-5). Discussion Critical incidents such as medical errors and unanticipated patient deaths are an unfortunate but inevitable part of the practice of medicine. The Interprofessional Collaborative Incident Response Training (I-CIRT) is a workshop intended to give clinician trainees an opportunity to learn and practice essential skills for communicating critical incidents to patients and their families.
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