Framing Family Conversation After Early Diagnosis of Iatrogenic Injury and Incidental Findings

Introduction: Both biliary injury and biliary malignancy can be devastating to patients and their families. Surgeons are rarely formally trained in giving bad news to patients. The aim of our study was to examine and compare disclosure of iatrogenic and incidental operative findings among surgical residents.

Methods: General surgery residents (PGY1-PGY5) performed a laparoscopic cholecystectomy on the SurgicalSIM device in a mock operating room. Eight residents were presented with a common bile duct injury during the operation, and seven residents encountered an incidental finding of metastatic gallbladder cancer. Both groups disclosed this information to a patient’s scripted family member. All disclosure encounters were videotaped and independently rated using a modified SPIKES protocol, a validated tool for delivering bad news. Residents also completed a questionnaire following the simulation. We compared disclosure of iatrogenic versus unexpected findings by year of training. Analysis was performed by two-sample Wilcoxon rank-sum (Mann-Whitney) test and one-sided Fisher’s exact test.

Results: Regardless of the year of training, more residents were comfortable with disclosure of an incidental finding than disclosure of an iatrogenic injury (47% vs. 33%). Amongst junior residents (PGY1-PGY2), none were comfortable with disclosure of iatrogenic injuries, and 20% were comfortable with disclosure of an incidental finding. In contrast, senior residents (PGY4-PGY5) overall had better ratings in all parameters evaluated with the modified SPIKES protocol for delivering bad news, using 3 independent reviewers (p


Session: Poster

Program Number: P162

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