Pack Rachael, Columbus Lauren, Duncliffe Trevor Hines, Banner Harrison, Singh Priyanka, Seemann Natashia, Taylor Taryn
Centre for Education Research & Innovation, Schulich School of Medicine & Dentistry, Western University, London, Canada.
Department of Midwifery, London Health Sciences Centre, London, Canada.
Adv Simul (Lond). 2022 Sep 24;7(1):31. doi: 10.1186/s41077-022-00227-y.
Simulation research that seeks to solve the problem of silence among interprofessional teams has focused almost exclusively on training subordinate team members to be more courageous and to speak up to team leaders using direct challenge scripts despite the great interpersonal cost. Consequently, the existing literature overemphasizes the responsibility of subordinate team members for speaking up and fails to consider the role and responsibilities of team leaders in sustaining silence. The purpose of this study is to identify and describe the subtle behaviors and actions of team leaders that both promote and discourage speaking up.
This study used a simulation-primed qualitative inquiry approach. Obstetricians (OB) at one academic center participated in an interprofessional simulation as an embedded participant. Five challenge moments (CM) were scripted for the OB involving deliberate clinical judgment errors or professionalism infractions. Other participants were unaware of the OB embedded participant role. Thirteen iterations were completed with 39 participants. Twelve faculty members completed a subsequent semi-structured interview. Scenarios were videotaped; debriefs and interviews were audio-recorded and transcribed verbatim. Data were analyzed using an inductive thematic approach.
After participating in an interprofessional simulation, faculty participants reflected that being an approachable team leader requires more than simply avoiding disruptive behaviors. We found that approachability necessitates that team leaders actively create the conditions in which team members perceive that speaking up is welcomed, rather than an act of bravery. In practice, this conceptualization of approachability involves the tangible actions of signaling availability through presence, uncertainty through thinking aloud, and vulnerability through debriefing.
By using faculty as embedded participants with scripted errors, our simulation design provided an ideal learning opportunity to prompt discussion of the subtle behaviors and actions of team leaders that both promote and discourage speaking up. Faculty participants gained a new appreciation that their actions create the conditions for speaking up to occur before critical incidents through their verbal and non-verbal communication.
旨在解决跨专业团队中沉默问题的模拟研究几乎完全集中在培训下属团队成员更有勇气，并使用直接挑战脚本来向团队领导表达意见，尽管这样做会带来巨大的人际成本。因此，现有文献过度强调下属团队成员表达意见的责任，而没有考虑团队领导在维持沉默方面的作用和责任。本研究的目的是识别和描述团队领导促进和抑制表达意见的微妙行为和行动。
本研究采用模拟引导的定性探究方法。一个学术中心的产科医生（OB）作为嵌入式参与者参加了一次跨专业模拟。为产科医生编写了五个挑战时刻（CM），涉及故意的临床判断错误或职业操守违规行为。其他参与者不知道产科医生的嵌入式参与者角色。共进行了13次模拟，有39名参与者。12名教员随后完成了半结构化访谈。模拟场景进行了录像；汇报会和访谈进行了录音并逐字转录。数据采用归纳主题分析法进行分析。
参与跨专业模拟后，教员参与者反映，成为一名平易近人的团队领导不仅仅是简单地避免破坏性行为。我们发现，平易近人要求团队领导积极创造条件，使团队成员认为表达意见是受欢迎的，而不是一种勇敢的行为。在实践中，这种平易近人的概念化涉及通过在场表明随时可及、通过大声思考表明不确定性以及通过汇报会表明脆弱性等切实行动。
通过将教员作为带有预设错误的嵌入式参与者，我们的模拟设计提供了一个理想的学习机会，以促使人们讨论团队领导促进和抑制表达意见的微妙行为和行动。教员参与者有了新的认识，即他们的行为通过言语和非言语交流为在关键事件发生前表达意见创造了条件。
