Young surgeons on speaking up: when and how surgical trainees voice concerns about supervisors' clinical decisions.
BACKGROUND
Poor communication is a known contributor to disasters in aviation and medicine. Crew members are trained to raise concerns about superiors' plans, yet literature exploring surgical trainees' responses to analogous concerns is sparse.


METHODS
Surgical residents were interviewed about approaches to concerns about supervisors' clinical decisions using a semistructured guide. Emerging themes were developed using the constant comparative method.


RESULTS
Eighteen residents participated. They expressed a tension between conceding ultimate decision-making authority to supervisors and prioritizing obligations to the patient. Systemic (eg, departmental culture, resident autonomy), supervisor (eg, approachability), trainee (eg, knowledge), and clinical (eg, risk of harm, evidence quality) factors influenced the willingness to voice concerns. Most described verbalizing concerns in question form, whereas some reported expressing concerns directly.


CONCLUSIONS
Several factors affect surgical trainees' management of concerns about supervisors' plans. No consistent method is used. A tailored curriculum addressing strategies to raise concerns appears warranted to optimize patient safety.
['Sur|Malini D|MD|', 'Schindler|Nancy|N|', 'Singh|Puneet|P|', 'Angelos|Peter|P|', 'Langerman|Alexander|A|']
D000367:Age Factors D001291:Attitude of Health Personnel D002983:Clinical Competence D000066491:Clinical Decision-Making D003479:Curriculum D005260:Female D006801:Humans D033183:Interdisciplinary Communication D007396:Internship and Residency D008297:Male D009042:Motivation D017009:Professional Autonomy D013043:Specialties, Surgical
Communication Surgical residents Patient safety Ethics Qualitative research