Disclosure rotation activity

Activity summary

This activity requires that small groups of learners move through up to 7 activity stations (A-G). The different activities and final class debrief are designed to help learners to reinforce their understanding of Physician-patient: Disclosure of patient safety incidents, particularly the disclosure roadmap. While each station would benefit from a tutor/facilitator, stations can be self-facilitated by learner groups. Stations can be removed to decrease the duration of the activity.

Activity description

Set-up

Depending upon available class time and the number of learners, choose up to 7 station activities (A-G) and set up the room accordingly. Station B should always follow station A. While each station would benefit from a tutor/facilitator, stations can be self-facilitated by learner groups. Ensure there are enough sets of instructions at each station.

In class

1. Divide learners into small groups and explain the upcoming activity.
2. Set a timer to allow groups to be at each station for 7 minutes.
3. Learners should be reminded to leave instructions at a station when they move to the next one. Any written notes created by the group, however, should travel with them.
4. Ensure that there is adequate time for a faculty-led debrief with the entire class upon completion of all stations.

Suggestions to faculty

A faculty-led debrief at the end of the activity will allow learners to share any concerns and ideas, as well as clarify content issues. Possible questions include:

1. Did you learn anything new about disclosure? Discuss.
2. For those who went to station A (Medications disclosure plan) before station B, did drafting a brief plan help the disclosure conversation? Discuss.
3. For those who went to station B (Medications disclosure role play) before station A, discuss the experience of disclosing without a plan.
4. Discuss the medical student's role in consent and disclosure discussions.
5. Ask some learners to read their documents from station F (Documenting disclosure). Have the class provide feedback. Are all relevant details included?
6. Discuss any differences between disclosing harm and near misses.
7. Ask learners to reflect on station G (You got served). Was there a difference when you were counseling a friend instead of yourself? How, and if so, why was it different?

Handout Station A – Medications disclosure plan

A physician prescribed a medication to a pregnant individual that had negative effects on the fetus.

1. Briefly discuss the disclosure responsibilities of the physician in this scenario.
2. a) If you have not yet been to station B, draft a written plan for disclosure using the disclosure roadmap to organize your thoughts.
   b) If you have been to station B, reflect on your disclosure role play.
• Did the discussion cover all elements of the disclosure roadmap?
• Would a plan have improved the disclosure conversation? Discuss.

Handout Station B – Medications disclosure role play

A physician prescribed a medication to a pregnant individual that had negative effects on the fetus.

Identify one individual as the patient and a second as the physician. Role play a disclosure conversation. Other group members should be prepared to provide feedback to the actors. Include consideration of the following questions:

• What went well with the disclosure?
• What could be improved?
• How was the patient feeling?
• How was the physician feeling?

If time allows, have 2 additional learners role play a disclosure conversation using feedback from the first role play.

Handout Station C – Informed consent dilemma

You are a medical student working with the staff radiologist, Dr. Fletcher, in a busy, tertiary care hospital. During an informed consent discussion with a patient undergoing a liver biopsy, Dr. Fletcher discussed the risk of hemorrhage and infection but did not discuss the risk of gallbladder injury and bile leak that could result from the procedure.

1. Discuss possible reasons why Dr. Fletcher did not identify all risks associated with a liver biopsy.
2. As a medical student, what is your role during this consent discussion?
1. Several days later you review the patient's medical chart and discover the patient suffered a gallbladder puncture during the procedure and subsequently bile peritonitis. Assume neither the patient nor Dr. Fletcher are aware of this information.
3. As a medical student, what should you do now, if anything?

Handout Station D – Preventing harm

Patient A in bed 3 was waiting for a barium swallow to investigate the cause of his dysphagia. After morning rounds, the attending physician accidentally placed the order for patient B in bed 4.

As a result of the procedure, patient B experienced some short-term nausea and vomiting, but no long-term sequelae.

1. Discuss the harm done in this case.
2. Discuss why disclosure should happen every time there is harm.
3. Draft some key points in a hospital procedure that are designed to prevent this type of incident.

Handout Station E – Learning from near misses

Mrs. Anna Lang, a 46-year-old female, needed to have her blood drawn for a biochemistry panel. The nurse approached Ms. Ann Lang, a 38-year-old female with the requisition. Just before she drew blood, the nurse asked Ms. Lang for her date of birth, and was able to recognize that she was with the wrong patient.

1. Should this near miss be disclosed to the patient? If so, which patient(s) should be advised and what information should be disclosed?
2. The possibility of near misses (incidents in Québec) and patient safety incidents (accidents in Québec) increases when two or more patients have the same name. Identify other scenarios that may increase the possibility of near misses and patient safety incidents in a healthcare setting.

Handout Station F – Documenting disclosure

Agatha Klemmings has suffered a patient safety incident (accident in Québec) while under your care. She is a 16-year-old patient who received methadone instead of methylphenidate for her attention deficit disorder due to an illegible prescription.

You just finished disclosing this information to Agatha and her parents. Agatha is extremely worried about the potential side effects of methadone.

Assume you are Agatha's physician. Create an entry to document this incident and disclosure conversation in her chart. Ensure your notes are concise and contain all relevant information (you can be creative with the details; accuracy of the medicine aspect is not important).

Handout Station G – You got served

You are a resident and have received your first statement of claim. Mr. Jones, a former patient, is seeking compensation for complications he experienced after surgery.

1. How would you cope with this situation?
2. What if this happened to a friend? What coping strategies would you recommend?
3. Who can you contact for support and guidance?

DISCLAIMER: The information contained in this learning material is for general educational purposes only and is not intended to provide specific professional medical or legal advice, nor to constitute a "standard of care" for Canadian healthcare professionals. The use of CMPA learning resources is subject to the foregoing as well as the CMPA's Terms of Use.