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Pediatric Trainees' Speaking Up About Unprofessional Behavior and Traditional Patient Safety Threats.

  • Kesselheim, Jennifer C1
  • Shelburne, Julia T2
  • Bell, Sigall K3
  • Etchegaray, Jason M4
  • Lehmann, Lisa Soleymani5
  • Thomas, Eric J6
  • Martinez, William7
  • 1 Boston Children's/Dana-Farber Cancer and Blood Disorders Center, Harvard Medical School (JC Kesselheim), Boston, Mass. Electronic address: [email protected]
  • 2 McGovern Medical School, Texas Children's Hospital, Baylor College of Medicine (JT Shelburne), Houston, Tex.
  • 3 Beth Israel Deaconess Medical Center, Harvard Medical School (SK Bell), Boston, Mass. , (Israel)
  • 4 RAND Corporation (JM Etchegaray), Santa Monica, Calif.
  • 5 National Center for Ethics in Health Care - U.S. Department of Veterans Affairs, Harvard Medical School, Harvard T.H. Chan School of Public Health (LS Lehmann), Boston, Mass.
  • 6 University of Texas Houston-Memorial Hermann Center for Healthcare Quality and Safety, McGovern Medical School, University of Texas Health Science Center at Houston (EJ Thomas).
  • 7 Division of General Internal Medicine, Vanderbilt University Medical Center, (W Martinez), Nashville, Tenn. Dr Shelburne is now with the Texas Children's Hospital, Baylor College of Medicine, Houston Tex.
Published Article
Academic pediatrics
Publication Date
Mar 01, 2021
DOI: 10.1016/j.acap.2020.07.014
PMID: 32673764


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. Copyright © 2020 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

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