1362. A Taste of Hell – Simulating the Litigation Experience for Residents

Authors: Gary Robert Simonds, MD, FAANS; Gary Simonds; Chris Busch; Michael Benko; Brendan Klein; Zev Elias; Brian Saway (Black Mountain, NC)

Introduction: We are concerned that residents are ill-prepared for the related harsh reality of malpractice deposition testimony and/or court room dramatics. We have sought to mitigate resident naiveté in this realm through experiential exercises in our weekly academic sessions. Methods: We routinely engage our residents (and ACP’s) in role-playing exercises related to malpractice litigation during our weekly academic sessions. Actual cases with associated complications or bad outcomes are employed. Cases selection is personalized to the resident (patients in whose care they were intimately involved). A one hour deposition is then conducted with litigation experienced neurosurgeons leading the plaintiff’s examination. The mock deposition is conducted before the entire team who are solicited for commentary only after the experience. The involved resident is then interviewed after the session. Paper and pencil surveys of the entire team are conducted. Results: Participating residents report becoming totally immersed in the scenarios with significant physiological and emotional reactions to the experience. Experienced witnesses report a strong sense of verisimilitude to the enactments. Residents report profound discomfort throughout the experience but uniformly consider it an invaluable exercise. Residents report tremendous growth in understanding of the process and how to navigate it. Particular areas of resonance included reflection on their own inadequate documentation, a sense of violation and injustice that must be overcome, control of emotions and limitation of aggressive responses, and tempering of the concept that the case can be won in the deposition. Conclusion: We believe regular role-playing exercises involving all sorts of stressful situations is an invaluable tool in the education of neurosurgical residents. It not only prepares cognitively for their challenges but also emotionally. Malpractice litigation is reported to be one of the most stressful experienced faced by neurosurgeons. We recommend initiation of such a experiential program in the training of neurosurgical residents.