Excuse Me: Teaching Interns to Speak Up

Background: A consistent finding in health care is that interns (junior physicians) are unwilling to "speak up" to attendings or consultants (senior physicians), which involves the related behaviors of challenging or questioning the actions of attendings, seeking guidance about one's own performance, and reporting one's errors. Training designed to encourage interns to speak up was designed, conducted, and evaluated at University Hospital Galway, an academic teaching hospital affiliated with the National University of Ireland, Galway, in January 2012-March 2012 and November 2012-January 2013. Method: Training, which was based on the Crew Resource Management model, was constructed around filmed stories of attending physicians describing situations in which, when they were interns, their communication and assertiveness skills were challenged, and their reflections on what they could have done better. Results: A total of 110 interns attended the training. The feedback from participants was positive. There was a significant increase in knowledge as a result of the training, and some evidence to support a shift in attitudes in the desirable direction relating to the need to speak up to seniors. No effect of the training was found on behavior. Conclusions: The willingness to share examples of poor performance is an important part of building a good safety culture. Listening to the stories of attendings describing and reflecting on a situation in which they struggled is a powerful teaching method for training interns in the communication and assertiveness skills that are critical to their job. However, a sustained change in attitudes and behavior to speaking up will require a reinforcement of learning with deliberate practice to develop the skills introduced through the training program.