TY - JOUR
T1 - Young surgeons on speaking up
T2 - When and how surgical trainees voice concerns about supervisors' clinical decisions
AU - Sur, Malini D.
AU - Schindler, Nancy
AU - Singh, Puneet
AU - Angelos, Peter
AU - Langerman, Alexander
N1 - Publisher Copyright:
© 2016 Elsevier Inc. All rights reserved.
PY - 2016/2/1
Y1 - 2016/2/1
N2 - Background Poor communication is a known contributor to disasters in aviation and medicine. Crew members are trained to raise concerns about superiors' plans, yet literature exploring surgical trainees' responses to analogous concerns is sparse. Methods Surgical residents were interviewed about approaches to concerns about supervisors' clinical decisions using a semistructured guide. Emerging themes were developed using the constant comparative method. Results Eighteen residents participated. They expressed a tension between conceding ultimate decision-making authority to supervisors and prioritizing obligations to the patient. Systemic (eg, departmental culture, resident autonomy), supervisor (eg, approachability), trainee (eg, knowledge), and clinical (eg, risk of harm, evidence quality) factors influenced the willingness to voice concerns. Most described verbalizing concerns in question form, whereas some reported expressing concerns directly. Conclusions Several factors affect surgical trainees' management of concerns about supervisors' plans. No consistent method is used. A tailored curriculum addressing strategies to raise concerns appears warranted to optimize patient safety.
AB - Background Poor communication is a known contributor to disasters in aviation and medicine. Crew members are trained to raise concerns about superiors' plans, yet literature exploring surgical trainees' responses to analogous concerns is sparse. Methods Surgical residents were interviewed about approaches to concerns about supervisors' clinical decisions using a semistructured guide. Emerging themes were developed using the constant comparative method. Results Eighteen residents participated. They expressed a tension between conceding ultimate decision-making authority to supervisors and prioritizing obligations to the patient. Systemic (eg, departmental culture, resident autonomy), supervisor (eg, approachability), trainee (eg, knowledge), and clinical (eg, risk of harm, evidence quality) factors influenced the willingness to voice concerns. Most described verbalizing concerns in question form, whereas some reported expressing concerns directly. Conclusions Several factors affect surgical trainees' management of concerns about supervisors' plans. No consistent method is used. A tailored curriculum addressing strategies to raise concerns appears warranted to optimize patient safety.
KW - Communication
KW - Ethics
KW - Patient safety
KW - Qualitative research
KW - Surgical residents
UR - http://www.scopus.com/inward/record.url?scp=84955689143&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84955689143&partnerID=8YFLogxK
U2 - 10.1016/j.amjsurg.2015.10.006
DO - 10.1016/j.amjsurg.2015.10.006
M3 - Article
C2 - 26691924
AN - SCOPUS:84955689143
SN - 0002-9610
VL - 211
SP - 437
EP - 444
JO - American Journal of Surgery
JF - American Journal of Surgery
IS - 2
ER -