1. Abstract Conclusions Methods Introduction Results Figures/Graphs Error disclosure is a critical skill for emergency medicine residents to develop There are multiple critical steps required to address the error correctly We assessed our residents ability to disclose medical errors Our results indicate that residents were weakest in explaining why errors occur and identifying errors of omission. Improvement can be focused on language that supports discussion of systems based errors with patients Abstract Assessing the Effectiveness of our Current Curriculum in Educating Residents in Medical Error Disclosure Our current curriculum includes hospital-based and residency-based activities to teach the principles of error disclosure Educational Objectives: To assess our current curriculum in error disclosure To create changes to the curriculum if necessary Residents were observed in a case-based scenario that included multiple errors of omission and commission Their answers were evaluated against a predetermined checklist of key principles in error disclosure Results were compiled to evaluate areas for improvement Background: Error disclosure is a critical skill for an emergency medicine resident’s professional development. When an error occurs, critical steps in addressing the error include: acknowledging to the patient that an error occurred, discussing the clinical relevance of the error, addressing systems-based issues that allowed the error to occur, taking steps to prevent future errors, and apologizing by the provider to those involved. Educational Objectives: To assess our current curriculum in error disclosure and to create changes to the curriculum if necessary. Curricular Design: Our current curriculum includes hospital-based and residency-based activities. Residents attend a mandatory medical center presentation on error disclosure; residency based small group discussions and individualized clinical experiences. We assessed the ability of our residents to apply the principle learned to a cased-based scenario that included multiple errors (omission and commission). Their answers were evaluated against a predetermined checklist of key principles in standard error disclosure. We compiled the results to evaluate areas for curricular improvement. 32 residents completed the assessment. 100% of residents acknowledged the error of commission (32/32), 34% of the residents did not recognize the error of omission (11/32). 31% did not explain the relevance of the error to the patient (10/32). 50% of the residents did not explain why the system allowed for the error (16/32). 15% did not describe how future errors would be prevented and 15% did not complete the critical step of apology (5/32). This data emphasized that our current curriculum requires improvement. In addition, residents have knowledge gaps in error disclosure, particularly in identifying and managing errors of omission and explaining why errors occur. Future goals will be to augment the medical center curriculum with an EM focused case-based discussion of error disclosure principles. Cases will focus on language that support discussion of systems-based errors with patients. The value and need for apology will be emphasized. Our current curriculum requires improvement Resident knowledge gaps are largest in errors of omission and explaining why they occur Future goal: to augment curriculum with EM focused case-based discussions and using language with patients that support discussion of systems-based errors Flavia Nobay MD, Linda Spillane MD, Julie Pasternack MD and Joseph Pereira DO University of Rochester Medical Center 100% recognized the error of commission 34% did not recognize the error of omission 31% did not explain the relevance of the error 50% did not explain why the system allowed the error 15% did not describe future error prevention 15% did not apologize

2. Abstract Conclusions Methods Introduction Results Figures/Graphs Error disclosure is a critical skill for emergency medicine residents to develop There are multiple critical steps required to address the error correctly We assessed our residents ability to disclose medical errors Our results indicate that residents were weakest in explaining why errors occur and identifying errors of omission. Improvement can be focused on language that supports discussion of systems based errors with patients Introduction Assessing the Effectiveness of our Current Curriculum in Educating Residents in Medical Error Disclosure Our current curriculum includes hospital based and residency based activities to teach the principles of error disclosure Educational Objectives: To assess our current curriculum in error disclosure To create changes to the curriculum if necessary Residents were observed in a case based scenario that included multiple errors of omission and commission Their answers were evaluated against a predetermined checklist of key principles in error disclosure Results were compiled to evaluate areas for improvement Our current curriculum requires improvement Resident knowledge gaps are largest in errors of omission and explaining why they occur Goal in future to augment curriculum with EM focused case based discussions and using language with patients that support discussion of systems based errors Flavia Nobay MD, Linda Spillane MD, Julie Pasternack MD and Joseph Pereira DO University of Rochester Medical Center 100% recognized the error of commission 34% did not recognize the error of omission 31% did not explain the relevance of the error 50% did not explain why the system allowed the error 15% did not describe future error prevention 15% did not apologize Error disclosure is a critical skill for emergency medicine residents There are several vital actions required to address a medical error Notify the patient that an error occurred Discuss the relevance of the error Address systems-based issues that allowed the error to occur Understand steps to prevent future errors Apologize to the patient and others involved Our resident curriculum includes hospital-based and residency- based activities to teach these actions Hospital based Mandatory medical center presentation Residency based Small-group discussions Individualized clinical experiences Our objective was to assess our current curriculum and to create changes to the curriculum if necessary

3. Abstract Conclusions Methods Introduction Results Figures/Graphs Error disclosure is a critical skill for emergency medicine residents to develop There are multiple critical steps required to address the error correctly We assessed our residents ability to disclose medical errors Our results indicate that residents were weakest in explaining why errors occur and identifying errors of omission. Improvement can be focused on language that supports discussion of systems based errors with patients Methods Assessing the Effectiveness of our Current Curriculum in Educating Residents in Medical Error Disclosure Our current curriculum includes hospital based and residency based activities to teach the principles of error disclosure Educational Objectives: To assess our current curriculum in error disclosure To create changes to the curriculum if necessary Residents were observed in a case based scenario that included multiple errors of omission and commission Their answers were evaluated against a predetermined checklist of key principles in error disclosure Results were compiled to evaluate areas for improvement Our current curriculum requires improvement Resident knowledge gaps are largest in errors of omission and explaining why they occur Goal in future to augment curriculum with EM focused case based discussions and using language with patients that support discussion of systems based errors Flavia Nobay MD, Linda Spillane MD, Julie Pasternack MD and Joseph Pereira DO University of Rochester Medical Center 100% recognized the error of commission 34% did not recognize the error of omission 31% did not explain the relevance of the error 50% did not explain why the system allowed the error 15% did not describe future error prevention 15% did not apologize We created a written case based scenario Using a predetermined checklist, residents were graded on ability to recognize the error of commission, omission, explain the relevance of the error, explain why the system allowed the error, describe future prevention, and apologize to the patients Results were compiled to evaluate areas for improvement The Case You are working in the ED on a busy shift and managing multiple patients You suspect John Smith in room 3 has a PE so you order a CT Chest Angiogram and then see some other patients An hour later you realize that you mistakenly ordered the CT on Ms. Robinson in room 2. When you call the CT Tech to cancel the order she tells you that Ms. Robinson unfortunately just completed the scan. What do you do next? Explain the steps you need to take to try and make this right and prevent it from happening again. Now write a follow up note about the incident as if you were writing it in the patient’s chart

4. Abstract Conclusions Methods Introduction Results Figures/Graphs Error disclosure is a critical skill for emergency medicine residents to develop There are multiple critical steps required to address the error correctly We assessed our residents ability to disclose medical errors Our results indicate that residents were weakest in explaining why errors occur and identifying errors of omission. Improvement can be focused on language that supports discussion of systems based errors with patients Assessing the Effectiveness of our Current Curriculum in Educating Residents in Medical Error Disclosure Our current curriculum includes hospital based and residency based activities to teach the principles of error disclosure Educational Objectives: To assess our current curriculum in error disclosure To create changes to the curriculum if necessary Residents were observed in a case based scenario that included multiple errors of omission and commission Their answers were evaluated against a predetermined checklist of key principles in error disclosure Results were compiled to evaluate areas for improvement Our current curriculum requires improvement Resident knowledge gaps are largest in errors of omission and explaining why they occur Goal in future to augment curriculum with EM focused case based discussions and using language with patients that support discussion of systems based errors Flavia Nobay MD, Linda Spillane MD, Julie Pasternack MD and Joseph Pereira DO University of Rochester Medical Center 100% recognized the error of commission 34% did not recognize the error of omission 31% did not explain the relevance of the error 50% did not explain why the system allowed the error 15% did not describe future error prevention 15% did not apologize

5. Abstract Conclusions Methods Introduction Results Figures/Graphs Error disclosure is a critical skill for emergency medicine residents to develop There are multiple critical steps required to address the error correctly We assessed our residents ability to disclose medical errors Our results indicate that residents were weakest in explaining why errors occur and identifying errors of omission. Improvement can be focused on language that supports discussion of systems based errors with patients Results Assessing the Effectiveness of our Current Curriculum in Educating Residents in Medical Error Disclosure Our current curriculum includes hospital based and residency based activities to teach the principles of error disclosure Educational Objectives: To assess our current curriculum in error disclosure To create changes to the curriculum if necessary Residents were observed in a case based scenario that included multiple errors of omission and commission Their answers were evaluated against a predetermined checklist of key principles in error disclosure Results were compiled to evaluate areas for improvement Our current curriculum requires improvement Resident knowledge gaps are largest in errors of omission and explaining why they occur Goal in future to augment curriculum with EM focused case based discussions and using language with patients that support discussion of systems based errors Flavia Nobay MD, Linda Spillane MD, Julie Pasternack MD and Joseph Pereira DO University of Rochester Medical Center 100% recognized the error of commission 34% did not recognize the error of omission 31% did not explain the relevance of the error 50% did not explain why the system allowed the error 15% did not describe future error prevention 15% did not apologize 32 residents total 100% recognized the error of commission (32/32) 34% did not recognize the error of omission (11/32) 31% did not explain the relevance of the error to the patient (10/32) 50% did not explain why the system allowed for the error (16/32) 15% did not describe how future errors will be prevented (5/32) 15% did not apologize to the patient (5/32)

6. Abstract Conclusions Methods Introduction Results Figures/Graphs Error disclosure is a critical skill for emergency medicine residents to develop There are multiple critical steps required to address the error correctly We assessed our residents ability to disclose medical errors Our results indicate that residents were weakest in explaining why errors occur and identifying errors of omission. Improvement can be focused on language that supports discussion of systems based errors with patients Future Goals Assessing the Effectiveness of our Current Curriculum in Educating Residents in Medical Error Disclosure Our current curriculum includes hospital based and residency based activities to teach the principles of error disclosure Educational Objectives: To assess our current curriculum in error disclosure To create changes to the curriculum if necessary Residents were observed in a case based scenario that included multiple errors of omission and commission Their answers were evaluated against a predetermined checklist of key principles in error disclosure Results were compiled to evaluate areas for improvement Our current curriculum requires improvement Resident knowledge gaps are largest in errors of omission and explaining why they occur Goal in future to augment curriculum with EM focused case based discussions and using language with patients that support discussion of systems based errors Flavia Nobay MD, Linda Spillane MD, Julie Pasternack MD and Joseph Pereira DO University of Rochester Medical Center 100% recognized the error of commission 34% did not recognize the error of omission 31% did not explain the relevance of the error 50% did not explain why the system allowed the error 15% did not describe future error prevention 15% did not apologize Develop a curriculum that includes didactic and small group discussion which focus on the principles of error disclosure Develop case-based scenarios that exemplify the errors of commission and omission Work with Patient Safety and Quality Improvement representatives to discuss systems based errors and disclosure of these errors Work in team-based simulations to practice the art of accountability and apology