Influence of surgeon behavior on trainee willingness to speak up: a randomized controlled trial.

BACKGROUND: Our aim was to determine if a surgeon's behaviors can encourage or discourage trainees from speaking up when they witness a surgical mistake. STUDY DESIGN: A randomized clinical trial in which medical students (n = 55) were randomly assigned to an "encouraged" (n = 28) or "discouraged" (n = 27) group. Participants underwent personality tests to assess decision-making styles, and were then trained on basic tasks ("burn" then "cut") on a laparoscopic surgery simulator. After randomization, students assisted at a simulated laparoscopic salpingectomy. The senior surgeon used either an "encourage" script (eg, "Your opinion is important.") or a "discourage" script (eg, "Do what I say. Save questions for next time."). Otherwise, the surgery was conducted identically. Subsequently, a surgical mistake was made by the senior surgeon when he instructed students to cut without burning. Students were considered to have spoken up if they questioned the instruction and did not cut. Potential personality bias was assessed with two validated personality tests before simulation. Data were processed with Mann-Whitney and Fisher exact tests. RESULTS: The students in the encouraged group were significantly more likely to speak up (23 of 28 [82%] vs 8 of 27 [30%]; p < 0.001). There was no statistically significant difference between the two groups in personality traits, student training level (p = 1.0), or sex (p = 0.53). CONCLUSIONS: A discouraging environment decreases the frequency with which trainees speak up when witnessing a surgical error. The senior surgeon plays an important role in improving intraoperative communication between junior and senior clinicians and can enhance patient safety.

The relationship of praise/criticism to learning during obstetrical simulation: a randomized clinical trial.

AIMS: The effect of positive vs. negative comments (praise vs. criticism) on trainees' subsequent cognitive and technical performance is unknown, but of potential importance. We performed a randomized trial of giving either praise or criticism during simulated normal vaginal deliveries (using a high-fidelity birthing simulator) to assess the differential effect of these types of comments on students' cognitive and technical performance, and perceived confidence after their learning experience. METHODS: Medical and nursing students underwent stratified randomization to praise or criticism. Students (n=59) initially participated in a teaching demonstration and practiced normal spontaneous vaginal delivery using a birthing simulator. A baseline assessment of cognitive and technical skills, and of self-confidence, was followed by a second simulation during which positive or negative comments were given using standardized scripts. Cognitive performance, technical performance and confidence measures were then scored again. RESULTS: Cognitive and technical performance scores in the "praise" group improved significantly by 2.5 (P=0.007) and 1.8 (P=0.032), respectively, while those in the "criticism" group remained unchanged. The self-reported confidence scores did not show any significant change from baseline in either group. CONCLUSIONS: Praise strengthens students' cognitive and technical performances, while criticism does not.

Improved performance of maternal-fetal medicine staff after maternal cardiac arrest simulation-based training.

OBJECTIVE: To determine the impact of simulation-based maternal cardiac arrest training on performance, knowledge, and confidence among Maternal-Fetal Medicine staff. STUDY DESIGN: Maternal-Fetal Medicine staff (n = 19) participated in a maternal arrest simulation program. Based on evaluation of performance during initial simulations, an intervention was designed including: basic life support course, advanced cardiac life support pregnancy modification lecture, and simulation practice. Postintervention evaluative simulations were performed. All simulations included a knowledge test, confidence survey, and debriefing. A checklist with 9 pregnancy modification (maternal) and 16 critical care (25 total) tasks was used for scoring. RESULTS: Postintervention scores reflected statistically significant improvement. Maternal-Fetal Medicine staff demonstrated statistically significant improvement in timely initiation of cardiopulmonary resuscitation (120 vs 32 seconds, P = .042) and cesarean delivery (240 vs 159 seconds, P = .017). CONCLUSION: Prompt cardiopulmonary resuscitation initiation and pregnancy modifications application are critical in maternal and fetal survival during cardiac arrest. Simulation is a useful tool for Maternal-Fetal Medicine staff to improve skills, knowledge, and confidence in the management of this catastrophic event.