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Citation
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Kesselheim JC, Shelburne JT, Bell SK, Etchegaray JM, Lehmann LS, Thomas EJ, Martinez W. Acad. Pediatr. 2020; ePub(ePub): ePub. |
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Abstract
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OBJECTIVES: Speaking up is increasingly recognized as essential for patient safety. We aimed to determine pediatric trainees' experiences, attitudes, and anticipated behaviors with speaking up about safety threats including unprofessional behavior.
METHODS: Anonymous, cross-sectional survey of 512 pediatric trainees at two large US academic children's hospitals that queried experiences, attitudes, barriers and facilitators, and vignette responses for unprofessional behavior and traditional safety threats.
RESULTS: Responding trainees (223/512, 44%) more commonly observed unprofessional behavior than traditional safety threats (57%, 127/223 vs. 34%, 75/223; P<0.001), but reported speaking up about unprofessional behavior less commonly (48%, 27/56 vs. 79%, 44/56; P<0.001). Respondents reported feeling less safe speaking up about unprofessional behavior than patient safety concerns (52%, 117/223 vs. 78%, 173/223; P<0.001). Respondents were significantly less likely to speaking up to, and use assertive language with, an attending physician in the unprofessional behavior vignette than the traditional safety vignette (10%, 22/223 vs. 64%, 143/223, P<0.001 and 12%, 27/223 vs. 57%, 128/223, P<0.001, respectively); these differences persisted even among respondents that perceived high potential for patient harm in both vignettes (20%, 16/81 vs. 69%, 56/81, P<0.001 and 20%, 16/81 vs. 69% (56/81), P<0.001, respectively). Fear of conflict was the predominant barrier to speaking up about unprofessional behavior and more commonly endorsed for unprofessional behavior than traditional safety threats (67%, 150/223 vs. 45%, 100/223; P<0.001).
CONCLUSIONS: Findings suggest pediatric trainee reluctance to speak up when presented with unprofessional behavior compared to traditional safety threats and highlight a need to improve elements of the clinical learning environment to support speaking up.
Language: en |