Saying Sorry: Junior doctors’ experiences of open disclosure following medication error. A phenomenological study using medical simulation

Abstract

Open disclosure is a policy stating doctors should apologise for errors, discussing them with the harmed parties. The aim of this thesis was to explore the current practice of open disclosure by junior doctors, and develop an educational framework that ensured reflective clinical practice. I conducted a Phenomenological study of medical interns involved in open disclosure in three parts. Firstly, ten interns were interviewed illuminating their clinical experiences of open disclosure. Eight medical students then underwent a hi-fidelity simulation session followed by focus-group discussions. Finally, the eight medical students were interviewed during their intern year, illuminating their experiences of open disclosure and their reflection on the simulation session. Data was coded and analysed using Interpretative Phenomenological Analysis. Analysis of part one demonstrated three superordinate-themes; Rationalisation of medical error; Culture of medical error; Apology in practice. Analysis of part two demonstrated two superordinate-themes; Identifying learning needs; Learning to say sorry. Analysis of part three demonstrated two superordinate-themes; Retaining learning into practice; Planning future practice. Medical interns appeared to lack important elements in their knowledge frames, which made them more prone to making errors. Their knowledge frames and actions demonstrated conscious incompetence associated with rationalisation, and unconscious incompetence associated with cognitive dissonance. The simulation education session gave medical students the psychological safety to take risks in their learning and develop a growth mindset and cognitive resilience. The role of an expert facilitator was vital in providing the optimal learning environment. A learning model developed from the data suggested the presence of a cognitive trait, which was labelled ‘readiness to apologise’, meaning that the interns were; aware of the need to apologise; aware of the rationale to apologise; and aware of the want to apologise. Mentorship and guidance by educators is required to inspire learners to develop cognitive frameworks such as intellectual humility, a growth mindset, and situational awareness. This means that learners will reflect with the right people, at the right time, in the right manner.