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Randomized Controlled Trial Observational Study
Training novice anaesthesiology trainees to speak up for patient safety.
A neat little study...
Gurus and team showed improvement in assertiveness and 'speaking up' behaviour among junior anaesthesia trainees, during a simulation workshop after exposure to a didactic session on speaking up behaviour – when compared to a control simulation group who did not receive the didactic session. (n=22)
The take-home message
There is likely benefit to explicitly discussing the issue of, and most importantly techniques for, speaking up when anaesthesia trainees witness management errors or oversights.
The one short-coming
The effects were only observed in a simulation environment, and while probably applicable to the more-consequential real world, as with much simulation research we are often dependent on surrogate markers of performance improvement.
Nonetheless, "we don't rise to the level of our expectations, we fall to the level of our training",1 right?
summary
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This quote is usually attributed to the Greek poet Archilochus, over 2,500 years ago... though today popularised by the US Navy SEALs! (and perhaps a few medical simulation specialists 😉) ↩
- Rodrigo J Daly Guris, Shirley S Duarte, Christina R Miller, Adam Schiavi, and Serkan Toy.
- Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: dalygurisr@email.chop.edu.
- Br J Anaesth. 2019 Jun 1; 122 (6): 767-775.
BackgroundEffectively communicating patient safety concerns in the operating theatre is crucial, but novice trainees often struggle to develop effective speaking up behaviour. Our primary objective was to test whether repeated simulation-based practice helps trainees speak up about patient management concerns. We also tested the effect of an additional didactic intervention over standard simulation education.MethodsThis prospective observational study with a nested double-blind, randomised controlled component took place during a week-long simulation boot camp. Participants were randomised to receive simulation education (SE), or simulation education plus a didactic session on speaking up behaviour (SE+). Outcome measures were: changes in intrapersonal factors for speaking up (self-efficacy, social outcome expectations, and assertiveness), and speaking up performance during four simulated scenarios. Participants self-reported intrapersonal factors and blinded observers scored speaking up behaviour. Cognitive burden for each simulation was also measured using the National Aeronautics and Space Administration Task Load Index. Mixed-design analysis of variance was used to analyse scores.ResultsTwenty-two participants (11 per group) were included. There was no significant interaction between group and time for any outcome measure. There was a main effect for time for self-efficacy (P<0.001); for social outcome expectations (P<0.001); for assertive attitude (P=0.003); and for speaking up scores (P=0.001). The SE+ group's assertive attitude scores increased at follow-up whereas the SE group reverted to near baseline scores (P=0.025).ConclusionsIn novice anaesthesia trainees, intrapersonal factors and communication performance benefit from repeated simulation training. Focused teaching may help trainees develop assertive behaviours.Copyright © 2019 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.
Notes
A neat little study...
Gurus and team showed improvement in assertiveness and 'speaking up' behaviour among junior anaesthesia trainees, during a simulation workshop after exposure to a didactic session on speaking up behaviour – when compared to a control simulation group who did not receive the didactic session. (n=22)
The take-home message
There is likely benefit to explicitly discussing the issue of, and most importantly techniques for, speaking up when anaesthesia trainees witness management errors or oversights.
The one short-coming
The effects were only observed in a simulation environment, and while probably applicable to the more-consequential real world, as with much simulation research we are often dependent on surrogate markers of performance improvement.
Nonetheless, "we don't rise to the level of our expectations, we fall to the level of our training",1 right?
-
This quote is usually attributed to the Greek poet Archilochus, over 2,500 years ago... though today popularised by the US Navy SEALs! (and perhaps a few medical simulation specialists 😉) ↩
Daniel Jolley
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