Abstract
Objectives
Little is known about medical students’ speak-up barriers upon recognizing or becoming aware of risky or deficient actions of others. Improving our knowledge on these helps in preparing student to function in actual health care organizations. The aim was to examine medical students' perceived reasons for silence in respect to different speak-up situations (i.e., vignette content) and to test if vignette difficulty had an effect on reasons indicated.
Methods
This study was a randomized, controlled, single-blind trial, with text-based vignettes to investigate speak-up barriers. Vignette contents described speak-up situations that varied systematically with respect to speak-up barrier (i.e., environmental norm, uncertainty, hierarchy) and difficulty (i.e., easy, difficult). For each vignette, participants indicated which speak-up barriers they regarded as important.
Descriptive analysis was performed for the study population, the numbers of barriers perceived and rating of vignette difficulty. Logistic regression analysis was used to examine the association between barriers perceived and vignette contents, designed vignette difficulty and subjectively rated vignette difficulty.
Results
A total of 265 students were included. The response rate was 100%. Different barriers were relevant for the different vignettes and varied in a consistent way with the theme of the vignette. Significantly more speak-up barriers were indicated for participants with the difficult version for vignette 1 (not an environmental norm) and vignette 3 (hierarchy) with odds ratio (OR) = 1.52 and 95% confidence interval (95% CI: 1.33–1.73) and OR = 1.25 (95% CI: 1.09–1.44). For (OR) estimates, confidence intervals were rather large.
Conclusions
Perceived barriers for speak-up vary consistently with the characteristics of the situation and more barriers preventing speak-up were related to the difficult versions of the vignettes.
Little is known about medical students’ speak-up barriers upon recognizing or becoming aware of risky or deficient actions of others. Improving our knowledge on these helps in preparing student to function in actual health care organizations. The aim was to examine medical students' perceived reasons for silence in respect to different speak-up situations (i.e., vignette content) and to test if vignette difficulty had an effect on reasons indicated.
Methods
This study was a randomized, controlled, single-blind trial, with text-based vignettes to investigate speak-up barriers. Vignette contents described speak-up situations that varied systematically with respect to speak-up barrier (i.e., environmental norm, uncertainty, hierarchy) and difficulty (i.e., easy, difficult). For each vignette, participants indicated which speak-up barriers they regarded as important.
Descriptive analysis was performed for the study population, the numbers of barriers perceived and rating of vignette difficulty. Logistic regression analysis was used to examine the association between barriers perceived and vignette contents, designed vignette difficulty and subjectively rated vignette difficulty.
Results
A total of 265 students were included. The response rate was 100%. Different barriers were relevant for the different vignettes and varied in a consistent way with the theme of the vignette. Significantly more speak-up barriers were indicated for participants with the difficult version for vignette 1 (not an environmental norm) and vignette 3 (hierarchy) with odds ratio (OR) = 1.52 and 95% confidence interval (95% CI: 1.33–1.73) and OR = 1.25 (95% CI: 1.09–1.44). For (OR) estimates, confidence intervals were rather large.
Conclusions
Perceived barriers for speak-up vary consistently with the characteristics of the situation and more barriers preventing speak-up were related to the difficult versions of the vignettes.
| Originalsprog | Engelsk |
|---|---|
| Tidsskrift | Journal of Patient Safety |
| Vol/bind | 20 |
| Udgave nummer | 5 |
| Sider (fra-til) | 323-329 |
| Antal sider | 7 |
| ISSN | 1549-8417 |
| DOI | |
| Status | Udgivet - 2024 |
Bibliografisk note
Funding Information:Jesper Dybdal, Annette Kj\u00E6r Ersb\u00F8ll, Michaela Kolbe, and Doris \u00D8stergaard have no disclosure. Dieckmann holds a professorship with the University in Stavanger, Norway, that was established with an unconditional grant by the Laerdal foundation to the University and that is now financed by the university itself. He is in the board of the EuSim Group providing facilitator courses.
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