Kesselheim Jennifer C, Shelburne Julia T, Bell Sigall K, Etchegaray Jason M, Lehmann Lisa Soleymani, Thomas Eric J, Martinez William
Boston Children's/Dana-Farber Cancer and Blood Disorders Center, Harvard Medical School (JC Kesselheim), Boston, Mass.
McGovern Medical School, Texas Children's Hospital, Baylor College of Medicine (JT Shelburne), Houston, Tex.
Acad Pediatr. 2021 Mar;21(2):352-357. doi: 10.1016/j.acap.2020.07.014. Epub 2020 Jul 14.
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.
Anonymous, cross-sectional survey of 512 pediatric trainees at 2 large US academic children's hospitals that queried experiences, attitudes, barriers and facilitators, and vignette responses for unprofessional behavior and traditional safety threats.
Responding trainees (223 of 512, 44%) more commonly observed unprofessional behavior than traditional safety threats (57%, 127 of 223 vs 34%, 75 of 223; P < .001), but reported speaking up about unprofessional behavior less commonly (48%, 27 of 56 vs 79%, 44 of 56; P < .001). Respondents reported feeling less safe speaking up about unprofessional behavior than patient safety concerns (52%, 117 of 223 vs 78%, 173 of 223; P < .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 of 223 vs 64%, 143 of 223, P < .001 and 12%, 27 of 223 vs 57%, 128 of 223, P < .001, respectively); these differences persisted even among respondents that perceived high potential for patient harm in both vignettes (20%, 16 of 81 vs 69%, 56 of 81, P < .001 and 20%, 16 of 81 vs 69%, 56 of 81, P < .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 of 223 vs 45%, 100 of 223, P < .001).
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.
直言不讳对于患者安全越来越被认为是至关重要的。我们旨在确定儿科实习医生对于说出包括不专业行为在内的安全威胁的经历、态度和预期行为。
对美国两家大型学术儿童医院的512名儿科实习医生进行匿名横断面调查，询问他们对于不专业行为和传统安全威胁的经历、态度、障碍和促进因素以及情景反应。
做出回应的实习医生（512名中的223名，44%）观察到不专业行为比传统安全威胁更为常见（57%，223名中的127名 vs 34%，223名中的75名；P <.001），但报告说出不专业行为的情况较少见（48%，56名中的27名 vs 79%，56名中的44名；P <.001）。与患者安全问题相比，受访者表示说出不专业行为时感觉更不安全（52%，223名中的117名 vs 78%，223名中的173名；P <.001）。在不专业行为情景中，受访者与主治医生直言不讳并使用坚定语言的可能性显著低于传统安全情景（分别为10%，223名中的22名 vs 64%，223名中的143名，P <.001；以及12%，223名中的27名 vs 57%，223名中的128名，P <.001）；即使在两个情景中都认为对患者有高潜在危害的受访者中，这些差异仍然存在（分别为20%，81名中的16名 vs 69%，81名中的56名，P <.001；以及20%，81名中的16名 vs 69%，81名中的56名，P <.001）。对冲突的恐惧是说出不专业行为的主要障碍，并且与传统安全威胁相比，更多人认可这是不专业行为的障碍（67%，223名中的150名 vs 45%，223名中的100名，P <.001）。
研究结果表明，与传统安全威胁相比，儿科实习医生在面对不专业行为时不愿直言不讳，并强调需要改善临床学习环境的要素以支持直言不讳。
