Do Surgical Residents Speak Up About Patient Safety Concerns? A National Survey Assessing Factors Associated With Resident Comfort Level in Raising Concerns to Supervising Physicians.

OBJECTIVE

Effective communication is integral to patient outcomes with communication failure cited as a major cause of medical errors. The comfort level of general surgery residents sharing concerns with supervising attendings and associated factors were investigated.

DESIGN

A cross-sectional survey for general surgery residents with Likert scale, objective-response, and free-response questions was administered. Quantitative data were analyzed with multivariable ordinal logistic regression models.

SETTING

General surgery residency programs in the United States.

PARTICIPANTS

A total of 162 general surgery residents from across the country responded.

RESULTS

Of 162 respondents, 159 (98%) acknowledged concerns regarding attendings' decisions at least annually, with 120 (74%) perceiving patient harm from suboptimal decisions. While 161 (99%) supported the importance of escalating concerns, 85 (52%) were uncomfortable speaking up in the operating room. Factors identified as "very important" for speaking up included department culture, rapport with attending, self-perceived medical knowledge, and severity of potential harm to patient (all>50%). Forty-six (28%) respondents received formal communication training. Eighty (49%) respondents were uncertain that program leadership would support raising concerns. Factors associated with increased comfort in speaking up intraoperatively included prior communication training (OR: 2.2; 95% CI: 1.6-4.2, p < 0.01), increased postgraduate year (OR: 4.3, 95% CI: 2.3-8.1, p < 0.01), and male gender (OR: 2.7, 95% CI: 1.5-5.1, p < 0.01). Established escalation protocols and residency program details (location/institution type) were not (p > 0.05).

CONCLUSIONS

Not all general surgery residents are comfortable raising patient safety concerns. Resident communication training is associated with increased comfort, and widespread adoption of such curricula may be valuable. However, residency program culture and supervising attending behavior appear to contribute to communication hesitancy. These issues should be addressed with faculty as well as institutional and program leadership.