What if they have no good examples?

Today I heard a presentation from Dr. Rachel Bonnema on teaching residents how to disclose medical errors. She is finishing a fellowship in internal medicine at the University of Pittsburgh in General Internal Medicine and Women's Health and was asked to develop a curriculum for the OB-GYN residents to teach them to disclose medical errors.

These are certainly high level communication skills. Numerous studies have found that patients want and expect physicians to disclose medical errors, but physicians rarely disclose such errors, for any number of reasons from fear of lawsuits to the belief that patients don't want to know.

So Dr. Bonnema set out to design an innovative curriculum, complete with standardized patients (trained actors who actually cry). It's an intense experience for the residents and Dr. Bonnema is planning to do follow-up research to see if the training sticks.

But one of the questions raised was how do you teach residents a skill that practicing physicians do such a poor job of themselves? The residents may have no mentors after which to model their communication skills. It is a difficult tide to turn. Once these physicians are in practice outside of the confines of residency, they can easily fall into the practices of the physicians around them. This is a question for all physician communication training programs conducted in medical school and residency. How do we get this training in effective communication to stick once these young doctors are in the working world, surrounded by doctors who may not be good examples? How do we inspire young doctors to turn the cultural tide?

The Wall Street Journal health blog posted this related blog on Wednesday http://blogs.wsj.com/health/2007/10/31/does-medical-liability-mean-never-saying-youre-sorry/