title: Assessing residents' disclosure of adverse events: traditional objective structured clinical examinations versus mixed reality.
abstract: OBJECTIVE
  The skill of disclosing adverse events is difficult to assess. Assessment of this competency in medical trainees is commonly achieved via the objective structured clinical examination (OSCE) using a standardized patient (SP). We hypothesized that the addition of a simulated clinical adverse event prior to the SP encounter could increase trainees' engagement and empathy, thereby improving performance. The objective of this study was to explore whether experiencing a simulated adverse event prior to an SP encounter alters resident performance on a disclosure OSCE.
  
  
  METHODS
  Sixteen obstetrics and gynaecology residents participated in this mixed methods study. Prior to disclosing the complication in an SP encounter, residents were randomized either to receive a written description of an adverse event, or to experience a mannequin simulation of an adverse event. Mean OSCE scores from blinded examiners were compared in each group. Focus group discussions elicited residents' reflections on the experience of disclosing the adverse event.
  
  
  RESULTS
  The mean score was 16.6/23 ± 2.9 (range 10 to 20) for the traditional OSCE group and 16.9/23 ± 1.7 (range 15 to 20) for the simulation group. Analysis of the focus group data revealed several themes, such as the type of context the residents desired, the emotional involvement they felt, and their insights about their experience of the simulation scenario or with the SP.
  
  
  CONCLUSIONS
  The assessment of adverse event disclosure was not enhanced by the addition of a simulated experience. Study participants reported that the simulation did not provide the contextual information required to elicit empathy and a sense of being emotionally invested in the adverse event.
authors.affiliation: Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON.
authors.forename: Glenn
authors.initials: G
authors.lastname: Posner
authors.forename: Viren
authors.initials: V
authors.lastname: Naik
authors.forename: Erin
authors.initials: E
authors.lastname: Bidlake
authors.forename: Amy
authors.initials: A
authors.lastname: Nakajima
authors.forename: Benjamin
authors.initials: B
authors.lastname: Sohmer
authors.forename: Abeer
authors.initials: A
authors.lastname: Arab
authors.forename: Lara
authors.initials: L
authors.lastname: Varpio
mesh_terms: D030881:Disclosure; D004521:Educational Measurement / Q000379:methods*; D004645:Empathy; D017144:Focus Groups; D006176:Gynecology / Q000193:education*; D007396:Internship and Residency; D019300:Medical Errors / Q000009:adverse effects / Q000523:psychology; D011446:Prospective Studies; D012655:Self-Evaluation Programs; D016037:Single-Blind Method