Root Cause Analysis and Open Disclosure in Ob-Gyn


The resources and products created through this grant-funded project have been assembled into a curriculum and made available to APGO members for their use in teaching root cause analysis and open disclosure in ob-gyn to medical students and residents.

This project was developed through an educational grant from the APGO Medical Education Endowment Fund Grant Program. It has not been created or peer-reviewed by APGO and therefore the accuracy of the content cannot be endorsed by the organization.

Project Title: Root Cause Analysis and Open Disclosure in Obstetrics and Gynecology: an integrated simulation-based module to teach and assess best practice components

Institution: Boston University

Project Team: Jodi Abbott, MD, James Moses, MD, MPH, Rachna Vanjani, MD

Objectives:

  1. Develop an awareness of how easily medical errors are made
  2. Understand what the components of systems based care are
  3. Be introduced to how we evaluate the causes and prevention of error by performing a root cause analysis
  4. Understand the principles of clear patient communication and demonstrate the components of open disclosure

Time Required: The module requires 2 hours of didactic time which can be split into 1 hour increments or can be performed all at once. The students and residents at Boston University School of Medicine who participated in this module were taught the entire module in a 2-hour morning didactic session.

Equipment/Staffing Required:

  1. One computer – used to display the modules
  2. One projector – used to project the modules from computer to large classroom screen
  3. Fishbone Diagram printed out for appropriate number of students
  4. The three surveys (Self Assessment, Standardized Patient Checklist,Post-curriculum Assessment) printed out for the appropriate number of students
  5. First and second year medical students who would like to volunteer their time to participate as standardized patients.
    a. Ratio of standardized patients to physicians is 1:2
    b. An email needs to be sent to the standardized patient
    volunteers explaining their role prior to the class. The email
    should include a link to the circumcision video.
  6. One faculty member to lead the discussion before and after each video

Instructions for module: Depending on how many students you have and time allotted, you can split the students up into two groups (1 group to view video modules and 1 group to participate in disclosure role play) or keep them in 1 group.

PART I: Videos

Prior to playing videos, students should complete the Self Assessment.

Videos should be played in this order:

  1. Introduction video
  2. Root cause analysis video: Teaches students how to perform an RCA
  3. Introduction to medical error: Wrong baby circumcised: Students watch this video and then immediately after fill out the Fishbone Diagram and have a discussion about the video and root cause analysis
  4. Disclosure video: Students watch this video and then immediately after will participate in roleplay with standardized patients.

PART II: Role play of disclosure with standardized patients (Time allotted: 20 minutes):

The students (physicians) have 15 minutes to disclose the medical error (wrong baby circumcised) to the standardized patient (mother). At the end of the role-play the standardized patient will fill out the Standardized Patient Checklist and then bring the student in to give him/her feedback about their disclosure technique.

At the end of the role-play, the students will fill out a Post-curriculum Assessment.

Watch the Videos

Project Introduction Video
RCA Video
Introduction to Medical Error Video
Disclosure Video

Download the Handouts

Fisbone Diagram
Self Assessment
Standardized Patient Checklist
Post-curriculum Assessment

 

This project was developed through an educational grant from the APGO Medical Education Endowment Fund Grant Program. It has not been created or peer-reviewed by APGO and therefore the accuracy of the content cannot be endorsed by the organization.