How to Encourage Residents to Speak up

by Kurt Ullman •

Department chiefs and program directors are essential to developing an environment in which trainees feel comfortable speaking up. It rests on the shoulders of senior staff to do away with any lingering belief in the traditional adage a senior surgeon might share with a junior resident, “Call me anytime, but remember, it is a sign of weakness.”

In a recent editorial, Douglass Smink, MD, MPH, and John T. Mullen, MD, both with the department of surgery at Brigham and Women’s Hospital in Boston, recommended that all surgical educators incorporate escalation-of-care training into the curriculum for junior trainees, not only because they say it is quality education, but also because the training has a high likelihood of improving patient care and safety (Ann Surg. 2016;263:427). Drs. Smink and Mullen said that escalation of care, like many other non-technical skills, is an essential skill that can be taught and improved, and should be included in the curriculum for all junior physicians. They urged senior physicians to provide support to residents so that speaking up in the name of patient safety is both encouraged and expected.

Kurt Ullman is a freelance medical writer based in Indiana.

Harvard Otorhinolaryngology System Triggers for Attending Communication

  • Admission/discharge
  • Transfer in/out of ICU
  • Unplanned intubation
  • Cardiac arrest or hemodynamic instability
  • Neurological changes
  • Wound complications
  • Any medication or therapeutic error that leads to a change in patient management
  • Unplanned transfusion
  • Any clinical problem requiring an invasive procedure
  • ER visit
  • Any concern by a trainee that a situation is more complicated than he or she can manage
  • Any request that an attending surgeon be contacted
  • Any situation in which a parent requests attending notification or feels that an issue has not been adequately resolved or addressed
  • Any new onset/worsening of symptoms out of proportion to expectations

Source: Boston Children’s Hospital Department of Otolaryngology and Communication Enhancement.

Hospitalists as Test Subjects

  1. Any new airway symptoms
  2. Epiglottitis
  3. Bronchial foreign body
  4. Laryngotracheal foreign body
  5. Bleeding from tracheotomy tube
  6. Orbital cellulitis
  7. Deep neck infection
  8. Post-tonsillectomy bleeding; see in ED immediately

Source: Boston Children’s Hospital Department of Otolaryngology and Communication Enhancement.