HEEALing after an error – use of the novel mnemonic HEEAL to structure error disclosure to patients and peers

Abstract

First, to determine the feasibility of providing a simple educational intervention using the HEEAL (Honesty, Empathy, Educate, Apology/awareness, Lessen the chance for future errors) mnemonic. Second, to assess the intervention’s ability to improve communication self-efficacy, knowledge and objective measures of error disclosure competence among providers. A 1-day (6-hour) pilot medical error curriculum was created to teach the HEEAL method of medical error disclosure to both patients and peers who have committed errors. The four-part curriculum consists of pre-intervention evaluation, HEEAL content lecture, rapid cycle deliberate practice (RCDP) with debriefing and post-intervention evaluation. This curriculum was repeated twice. The first training focused on medical error disclosure to patients’ families and the second on medical error disclosure to involved peers. Participating faculty developed, adapted and piloted simulation cases, skills checklists and knowledge questionnaires. The barriers to error disclosure assessment (BEDA) tool served as our confidence survey. Five additional questions developed and piloted by the research team were administered with the BEDA to assess learner confidence with peer–peer disclosure. Pre- and post-intervention written measures of knowledge and confidence (BEDA) were obtained for both iterations of the curriculum. Assessment of observed clinical skills was scored by the involved SP (standardized patient) immediately following the RCDP. An Fourteen learners completed all curricular components. Learners demonstrated statistically significant improvement in their confidence in medical error disclosure ( This pilot data suggest that the HEEAL intervention provides an effective and efficient way for medical educators to teach senior medical students how to provide competent error disclosure to both patients and peers.