Medical residents are less likely to report unprofessional behavior than they are a more traditional safety event, even though unprofessional behavior can result in patient harm, according to a study in BMJ Quality & Safety.
Additionally, residents are even less likely to point out a possible patient harm event if it involves an attending physician rather than a nurse or another resident.
Researchers surveyed 837 medical residents and interns at six academic medical centers, asking them to self-report the likelihood they would speak up and the potential for patient harm in two scenarios — a clinician breaching a sterile field while placing a catheter, and a clinician texting while rounding on new patients.
In the traditional safety threat event, nine in 10 respondents would speak up if it were a nurse or another intern or resident, but just six in 10 if the problem involved an attending physician, according to AMA Wire coverage of the study.
The number of residents who would report a problem decreased dramatically in the professionalism story, with 9 percent saying they would speak up if it was an attending physician acting unprofessionally.
"Power differential is one of the many drivers of whether or not people feel comfortable speaking up around a variety of concerns," William Martinez, MD, a co-author of the study, told AMA Wire. "One of the other main drivers is psychological safety — what you anticipate the response to be and whether or not you anticipate there to be a confrontational response or some sort of consequence. … What we're seeing is that, at least the residents in our study perceived there to be a lesser degree of psychological safety and a power differential that drove the difference" in response rates.
The study concludes, "Interns and residents commonly observed unprofessional behavior yet were less likely to speak up about it compared with traditional safety threats even when they perceived high potential [for] patient harm."