The Neurology Milestones Project and ACGME Program Requirements state that residents must report errors and participate in real or simulated disclosures of patient safety events. There were no studies in the neurology literature utilizing the validated and published Error Disclosure Rating Scale (EDRS) or the Safety Attitudes Questionnaire (SAQ)-one of the best-studied surveys on patient safety culture.

Two ACGME-accredited programs participated. Residents completed the SAQ. Error-disclosure simulations were developed. Residents read the vignettes, then disclosed their error to a standardized patient. The PI rated and debriefed each resident. Afterwards, residents watched a video on error disclosure. Approximately 1 month later, residents participated in a second simulation.

Mean SAQ scores were 87.2/100, indicating residents felt encouraged to report errors and that their institutions were safe environments.

Mean EDRS scores (n=14) on the first simulation ranged from fair-good: medical facts (2.9/5); honesty/truthfulness (2.9/5); empathy (2.1/5); prevention of errors (1.4/5); general communication skills (2.9/5); and total score (12/25 (SD=3.11)). During the first simulation, most residents focused on explaining medical mechanisms and pathophysiology-often using medical jargon. Some were unsure of how much detail to provide, did not express empathy, and neglected to discuss prevention of errors. Scores on the second simulation (n=8) ranged from good-excellent: medical facts (4/5); honesty/ truthfulness (4.5/5); empathy (3.4/5); prevention of errors (2.4/5); general communication skills (4.1/5); and total score (18.4/25 (SD=2.97)). A non-parametric Wilcoxon Signed Ranks Test indicated the improvements in total scores were statistically significant (Z=2.38, p=.02).

Implementation of our error disclosure curriculum informed us residents felt encouraged to report errors, but were unsure of how to do so. After individualized debriefing and instruction on error disclosure, meaningful and statistically significant improvements were observed. This curriculum was effective in training residents in error disclosure.