The FIRST Curriculum: Cultivating Speaking Up Behaviors in the Clinical Learning Environment

Expressing concerns that arise during patient care is essential to protecting patient safety. A speaking up episode occurs within a power hierarchy and carries high potential for personal and professional consequences. Existing curricula that promote speaking up, such as TeamSTEPPS (TM), extensively focus on verbal skills without recognizing the important emotional dimensions of speaking up. We developed the FIRST Speaking Up curriculum that covered the following: (a) inner barriers related to expectations of one's own identity, (b) cognitive distortions associated with speaking up, (c) the speaking up environment, (d) dialogue skills for the speaker and the listener, and (e) resilience strategies. The curriculum was delivered via 2 to 3 hours of interactive workshops to 109 participants, including 40 nursing staff and leaders, 24 plastic surgery residents, and 45 internal medicine residents. Evidence showed that training improved participants' motivations to speak up concerns. Our work expands on existing strategies for speaking up training by targeting both verbal and emotional skills.