Ian C Fischer1, Richard M Frankel2,3,4. 1. Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA. 2. Indiana University School of Medicine, Indianapolis, IN, USA. rfrankel@iu.edu. 3. VA Center for Health Information and Communication, Indianapolis, IN, USA. rfrankel@iu.edu. 4. Cleveland Clinic, Cleveland, OH, USA. rfrankel@iu.edu.
Abstract
BACKGROUND: Apologies may play a significant role in medical care, especially in the context of patient safety, medical error disclosure, and malpractice. Studies have shown that when state laws, institutional policies, and individual skills align-including the ability to offer a sincere apology-patients and families benefit. However, little is known about how, and under what conditions, physicians offer apologies in day-to-day care. Even less is known about what medical students learn about apologies from observing their superiors in these settings. OBJECTIVE: Characterize third-year medical students' experiences of observing and engaging in apologies. DESIGN: Qualitative descriptive analysis of student professionalism narratives. PARTICIPANTS: Third-year medical students at Indiana University School of Medicine. APPROACH: A search of 7,384 unique narratives yielded 238 with apologies. A rubric based on four key elements of genuine apologies ((1) acknowledgement, (2) explanation, (3) regret/remorse, and (4) reparation) was used to classify the kind of apology offered. Apology completeness, impact, and timing were also coded. KEY RESULTS: Seventeen percent of all apologies were complete (i.e., contained all four elements). Over 40% were coded as incomplete or "non-apology" apologies (i.e., those with only the first two elements). A significant relationship between apology completeness and positive student experience was found. Most apologies were offered by the attending physician or resident to patients and family members. Students were generally positive about their experiences, but one in five were coded as negative. Some students were distressed enough to offer apologies on behalf of the faculty. Apology timing did not make a significant difference in terms of student experience. CONCLUSIONS: Few education programs target apologies in the context of routine practice. With little formal instruction, students may rely on adopting what their seniors do. Faculty have an important role to play in modeling the apology process when harms-both great and small-occur.
BACKGROUND: Apologies may play a significant role in medical care, especially in the context of patient safety, medical error disclosure, and malpractice. Studies have shown that when state laws, institutional policies, and individual skills align-including the ability to offer a sincere apology-patients and families benefit. However, little is known about how, and under what conditions, physicians offer apologies in day-to-day care. Even less is known about what medical students learn about apologies from observing their superiors in these settings. OBJECTIVE: Characterize third-year medical students' experiences of observing and engaging in apologies. DESIGN: Qualitative descriptive analysis of student professionalism narratives. PARTICIPANTS: Third-year medical students at Indiana University School of Medicine. APPROACH: A search of 7,384 unique narratives yielded 238 with apologies. A rubric based on four key elements of genuine apologies ((1) acknowledgement, (2) explanation, (3) regret/remorse, and (4) reparation) was used to classify the kind of apology offered. Apology completeness, impact, and timing were also coded. KEY RESULTS: Seventeen percent of all apologies were complete (i.e., contained all four elements). Over 40% were coded as incomplete or "non-apology" apologies (i.e., those with only the first two elements). A significant relationship between apology completeness and positive student experience was found. Most apologies were offered by the attending physician or resident to patients and family members. Students were generally positive about their experiences, but one in five were coded as negative. Some students were distressed enough to offer apologies on behalf of the faculty. Apology timing did not make a significant difference in terms of student experience. CONCLUSIONS: Few education programs target apologies in the context of routine practice. With little formal instruction, students may rely on adopting what their seniors do. Faculty have an important role to play in modeling the apology process when harms-both great and small-occur.
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