• Anna B Newcomb, Chang Liu, Amber W Trickey, and Jonathan Dort.
• Division of Trauma, Department of Surgery, Inova Fairfax Medical Campus, Falls Church, Virginia. Electronic address: Anna.Newcomb@inova.org.
• J Surg Educ. 2018 Nov 1; 75 (6): e178-e191.

ObjectiveThe purpose of this effort was to create an educational experience that provided learners a realistic disclosure experience and improved resident confidence discussing an adverse outcome with a patient and family.DesignResidents practiced disclosing a surgical complication to a patient/family with simulated patients (SPs). We paired professional SPs with former patient SPs to present a realistic case. Junior residents were given extra training time before their disclosure of a laparoscopic cholecystectomy conversion to an open procedure; senior residents disclosed a bile duct injury. Residents rated pre and post-module confidence levels, and skills performance using the Disclosure of a Complication Checklist.Setting900-bed tertiary care hospital with surgical residency program and simulation center.ParticipantsGeneral surgery residents (PGY 1-5).ResultsEighteen residents participated in the disclosure module. Analysis of the medians and interquartile ranges of pre and post-module confidence scores showed significant improvement for each individual item and mean score of learners. Residents assessed their completion rates of individual Checklist tasks positively. For example, 94% self-endorsed completion of "explanation of facts," 89% self-endorsed "took responsibility," and 78% self-endorsed "apologized sincerely." Self-rated competence scores from the Checklist were low: 7% indicated they would be "extremely comfortable" entrusting their loved one's care to themselves, 11% rated their ability to explain the facts as "outstanding," and 12% felt they were "outstanding" in their "ability to disclose a complication in a professional manner."ConclusionResidents received important skills practice in our disclosure training; disclosure confidence increased after participation. Residents scored high on completion of disclosure tasks and low on comfort and proficiency of those tasks. The Checklist provided a useful set of tasks to review and complete in the exercise. Separating residents by PGY level enabled senior residents to experience a more complex scenario and junior residents extra time to practice.Copyright © 2018 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

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