Teaching Residents to Question and Challenge Their Teachers: A Simulator Experience.: Research Abstract: 66

BACKGROUND: Trainees need to “speak up” at the bedside, often without hesitation, about potentially questionable patient care practices initiated by their instructors and team-members. We sought to determine if trainees could learn to speak up in these situations using a simulation model. METHODS: With informed consent, anesthesiology trainees participated in a simulated OR obstetrical scenario that presented opportunities to challenge (e.g., administration of a relatively contraindicated drug, performance of a potentially unsafe procedure). In each scenario, one challenge opportunity was designed to involve the anesthesia attending, surgeon, and circulating nurse (all confederates). In a post-scenario debriefing one of the investigators taught a conversational technique that combined “advocacy” (stating the resident’s observation, opinion or position) with “inquiry” (an open, curious request for the other person’s reasoning) as a method to initiate a challenge.1 Also, a “two-challenge” technique was promoted. A post-debriefing scenario was used to test the learning of the technique. Two investigators conducted post-hoc video review and 5-point rating of the quality of response for each challenge. Pre- and post-debriefing scores were pooled and the frequency of each score presented. RESULTS: Preliminary data from 14 (of a projected 40) residents suggest that, prior to debriefing, residents were reluctant and ineffective in challenging their teachers. After instruction in the “two-challenge” and “advocacy-inquiry” approaches, they were more effective in these exchanges. CONCLUSION: Effective, professional language for difficult conversations is particularly important in the medical field where teamwork has immediate effect on patient safety. Our results suggest that a curriculum utilizing simulation and debriefing can result in improved communication skills.Figure