Malini D Sur1, Nancy Schindler2, Puneet Singh3, Peter Angelos4, Alexander Langerman5. 1. Department of Surgery, University of Chicago Medicine, 5841 S. Maryland Ave., MC6040, Chicago, IL 60637, USA; MacLean Center for Clinical Medical Ethics, University of Chicago, 5841 S. Maryland Ave., MC6040, Chicago, IL 60637, USA. Electronic address: msur@post.harvard.edu. 2. Pritzker School of Medicine, University of Chicago, Chicago, IL, USA; Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA. 3. Department of Surgery, University of Chicago Medicine, 5841 S. Maryland Ave., MC6040, Chicago, IL 60637, USA; MacLean Center for Clinical Medical Ethics, University of Chicago, 5841 S. Maryland Ave., MC6040, Chicago, IL 60637, USA. 4. Department of Surgery, University of Chicago Medicine, 5841 S. Maryland Ave., MC6040, Chicago, IL 60637, USA; MacLean Center for Clinical Medical Ethics, University of Chicago, 5841 S. Maryland Ave., MC6040, Chicago, IL 60637, USA; Bucksbaum Institute for Clinical Excellence, University of Chicago, Chicago, IL, USA. 5. MacLean Center for Clinical Medical Ethics, University of Chicago, 5841 S. Maryland Ave., MC6040, Chicago, IL 60637, USA; Bucksbaum Institute for Clinical Excellence, University of Chicago, Chicago, IL, USA; Department of Otolaryngology-Head and Neck Surgery, University of Chicago Medicine, Chicago, IL, USA; Operative Performance Research Institute, University of Chicago, Chicago, IL, USA.
Abstract
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.
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.
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