The “Hidden Curriculum” and Residents' Attitudes about Medical Error Disclosure: Comparison of Surgical and Nonsurgical Residents

Speaking up about traditional and professionalism-related patient safety threats: a national survey of interns and residents

“…This may represent inherent personality differences between surgeons and internists,54 or elements of surgical versus medical culture that were not captured by the safety culture metrics in our study 55 56. In addition, male gender was associated with speaking up in the professionalism vignette but not in the traditional vignette, perhaps due to the more confrontational nature of addressing unprofessional behaviour21 22 and previously reported gender-based differences in confidence and empowerment 8 57.…”

‘Speaking up’ about patient safety concerns and unprofessional behaviour among residents: validation of two scales

“…Educational and organisational leaders might incorporate advanced communication skills for speaking up about safety and professionalism concerns into existing patient safety curricula and initiate curricular efforts that highlight collective accountability for the clinical learning environment, the importance of speaking up and the link between unprofessional behaviour and patient safety 8 25 32. Ensuring appropriate role modelling for learners and reducing medical hierarchy in favour of teamwork and collective accountability for safety will also be critical to promoting speaking up 16 19. In addition, mean scores for questions assessing resident perceptions of meaningful institutional change following speaking up about unprofessional behaviour were also notably low.…”

“…For residents, low on the medical hierarchy, speaking up when they observe threats to patient safety, including unprofessional behaviour, may be particularly challenging 16 17. A strong desire to ‘fit in with the team’ and fear of repercussions can trump the moral courage required to speak up about safety concerns and unprofessional behaviour 8.…”

“…A strong desire to ‘fit in with the team’ and fear of repercussions can trump the moral courage required to speak up about safety concerns and unprofessional behaviour 8. While educators focus on formal resident patient safety curricula,18 the hidden curriculum may be a more powerful ‘teacher’, suppressing speaking up, and shaping residents’ attitudes and behaviours 16 19. Recently, the Accreditation Council for Graduate Medical Education (ACGME) established the Clinical Learning Environment Review (CLER) programme to assess the role of quality and safety in residents’ learning environments, including a focus on professionalism concerns and ‘opportunities for residents to report errors, unsafe conditions, and near misses’ 20.…”

Professional Integrity and the Role of Medical Students in Professional Self-Regulation

“…Examples include a fear of possible retaliation by those in authority, a lack of self-confidence, a wish to fit in with the team, or a sense of discomfort or distress in reporting [18]. Retaliatory factors often include fear of lowered grades, negative comments that will be passed on leaders of other clinical rotations, poor evaluations on Dean's letters, or even worries that disclosures may threaten acceptance into desired residencies.…”