What a disclosure conversation has to carry
The ready to use rubric follows the disclosure checklist in AHRQ's CANDOR toolkit. It scores six parts of the conversation with the patient or family.
Set the stage
Confirm who should attend, what is known, who will lead the conversation, and what support the patient or family may need.
Hear the patient or family first
Ask what they understand, invite questions, and respond to emotion before moving through the facts.
State the facts without blame or speculation
Explain what happened and what it means for the patient. Separate confirmed facts from what the review has not established.
Offer a sincere apology
Acknowledge the harm or unexpected outcome directly and express regret in words that fit what is known.
Explain consequences and next steps
Describe the patient's care plan, immediate support, and what the organization will review next.
Commit to follow up and documentation
Name who will return, when they will return, and how the conversation and open questions will be documented.
What a program gets
Participants get feedback they can use on the next attempt, while programs review agreed individual or cohort views.
Evidence for a requirement you already carry
ACGME Common Program Requirement 4.9.g asks residents to demonstrate competence in disclosure of patient safety events, real or simulated. A scored simulated disclosure gives programs a reviewable record to use alongside other evidence.
Your disclosure policy, scored as written
Every institution running a CANDOR or CARe program has written its own disclosure policy and its own coaching script. We use those element definitions rather than substituting a generic checklist.
Private, repeatable practice
Learners can repeat a case in private before sharing the report with a faculty member, coach, or program.
The first one is not the real one
In a randomized trial of 146 residents, the largest improvement went to those who had never done a real disclosure. Practice is worth most to exactly the people who have not had to do this yet.
The frameworks behind the score
Each AI patient case names the published framework or institution-defined standard used for feedback. The report shows strengths and areas for practice, with the participant's own words behind each score.
AHRQ CANDOR: Disclosure communication
Agency for Healthcare Research and QualityThe ready to use rubric applies the CANDOR disclosure checklist to the spoken encounter.
Your own disclosure policy
YoursSend the approved policy or coaching script. We use its element definitions as written.
How scoring against a framework works, including the scope rule
Frequently asked questions
Why practice a conversation most clinicians will rarely have?
Because the gap between intention and action is enormous. In a survey of 538 physicians, residents, and students, 97% said they would disclose a hypothetical minor-harm error and 93% a major-harm error, but only 41% had ever disclosed an actual minor error and 5% an actual major one (Kaldjian et al., J Gen Intern Med, 2007). Whatever closes that gap, it is not knowing that disclosure is the right thing to do.
Does practice actually change the next disclosure?
In the published evidence, yes, measured on the next simulated disclosure. A randomized trial of 146 PGY2 residents found that scored feedback on a simulated disclosure improved performance on the next one (mean 3.26 versus 3.14, P=.01), with the largest gain among residents who had never done a real disclosure (3.33 versus 3.09, P=.007) (White et al., JAMA Network Open, 2024). A pre-post study of 55 PGY1s doing two standardized-patient disclosures four weeks apart found self-efficacy rose from 119.6 to 150.3 (P<.001) and external faculty ratings improved (P=.001) (Sukalich et al., Academic Medicine, 2014).
Does this count for our ACGME requirement?
That is the program's call, not ours. ACGME Common Program Requirement 4.9.g states that residents must demonstrate competence in using tools and techniques that promote patient safety and disclosure of patient safety events, real or simulated. A scored simulated disclosure is evidence a program can put behind that requirement. Whether it is sufficient is decided by the program and its reviewers.
Do TeamSTEPPS or AIDET work as disclosure rubrics?
Neither fits, and it is worth saying so plainly because both get suggested. TeamSTEPPS is team-facing, covering SBAR, check-back, call-out, and handoff, and it contains nothing about the conversation after harm. AIDET is a five-step service encounter script and is not a disclosure protocol. Score against a disclosure framework or against your own policy.
Who is this page for?
Designated Institutional Officials, quality officers, and the patient safety educators who already run disclosure training and have no way to show what it produced. It is about whether a clinician can hold the conversation competently, which is a training question rather than a risk-management one.
What this page does not claim
ClinicalSim is not endorsed by, affiliated with, or approved by the ACGME or AHRQ. Scores map to published frameworks; they do not establish compliance with any standard, which a surveyor determines against the institution's own policy.
ClinicalSim output is formative. It is evidence that informs program judgment, and it is not intended for employment, credentialing, privileging, licensure, or other high-stakes decisions.
Consistency between model runs is not the same thing as agreement with expert human raters. Faculty-rater validation on a customer's own rubric is the gate before any high-stakes use, and that work has not been done.
ClinicalSim does not predict patient experience scores, readmissions, safety events, claims, or other clinical or business outcomes. Any comparison with institution-held outcome data requires a separate study plan.
Formative scores must not be used for employment decisions, discipline, compensation, credentialing, privileging, or licensure. Institutions should set access, retention, and reporting rules before staff participate.
ClinicalSim has no evidence of any effect on malpractice claims, indemnity, defense cost, or time to resolution, and makes no such claim. The published evidence in this lane measures performance on the next simulated disclosure, which is what this page describes.