Article, 2024

Medical Students' Speak Up Barriers: A Randomized Controlled Trial With Written Vignettes.

Journal of Patient Safety, ISSN 1549-8417, 1549-8425, 1550-512x, 1525-5794, 10.1097/pts.0000000000001227

Contributors

Dybdal Kayser, Jesper [1] Ersbøll, Annette Kjaer 0000-0002-9407-3387 [2] Kolbe, Michaela Østergaard, Doris Dieckmann, Peter

Affiliations

  1. [1] Capital Region of Denmark
  2. [NORA names: Capital Region of Denmark; Hospital; Denmark; Europe, EU; Nordic; OECD];
  3. [2] University of Southern Denmark
  4. [NORA names: SDU University of Southern Denmark; University; Denmark; Europe, EU; Nordic; OECD]

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.

Keywords

Vignette 1, Written, action, analysis, association, barriers, care organizations, characteristics, confidence, confidence intervals, content, controlled trials, deficient actions, descriptive analysis, difficult version, difficulties, effect, health care organizations, hierarchy, interval, knowledge, logistic regression analysis, medical students, odds, odds ratio, organization, participants, perceived barriers, perceived reasons, population, randomization, randomized controlled trials, rate, ratio, reasons, regression analysis, response, response rate, silencing, single-blind trial, situation, students, study, study population, trials, vary, version, vignette content, vignettes

Data Provider: Digital Science