title: The Impact of Rudeness on Medical Team Performance: A Randomized Trial.
abstract: OBJECTIVE
  Iatrogenesis often results from performance deficiencies among medical team members. Team-targeted rudeness may underlie such performance deficiencies, with individuals exposed to rude behavior being less helpful and cooperative. Our objective was to explore the impact of rudeness on the performance of medical teams.
  
  
  METHODS
  Twenty-four NICU teams participated in a training simulation involving a preterm infant whose condition acutely deteriorated due to necrotizing enterocolitis. Participants were informed that a foreign expert on team reflexivity in medicine would observe them. Teams were randomly assigned to either exposure to rudeness (in which the expert's comments included mildly rude statements completely unrelated to the teams' performance) or control (neutral comments). The videotaped simulation sessions were evaluated by 3 independent judges (blinded to team exposure) who used structured questionnaires to assess team performance, information-sharing, and help-seeking.
  
  
  RESULTS
  The composite diagnostic and procedural performance scores were lower for members of teams exposed to rudeness than to members of the control teams (2.6 vs 3.2 [P = .005] and 2.8 vs 3.3 [P = .008], respectively). Rudeness alone explained nearly 12% of the variance in diagnostic and procedural performance. A model specifying information-sharing and help-seeking as mediators linking rudeness to team performance explained an even greater portion of the variance in diagnostic and procedural performance (R(2) = 52.3 and 42.7, respectively).
  
  
  CONCLUSIONS
  Rudeness had adverse consequences on the diagnostic and procedural performance of the NICU team members. Information-sharing mediated the adverse effect of rudeness on diagnostic performance, and help-seeking mediated the effect of rudeness on procedural performance.
authors.affiliation: Recanati School of Business, Faculty of Management, and Neonatology, Bnai Zion Medical Center, Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel; arik.riskin@gmail.com.
authors.forename: Arieh
authors.initials: A
authors.lastname: Riskin
authors.affiliation: Warrington College of Business Administration, University of Florida, Gainesville, Florida; and.
authors.forename: Amir
authors.initials: A
authors.lastname: Erez
authors.affiliation: Warrington College of Business Administration, University of Florida, Gainesville, Florida; and.
authors.forename: Trevor A
authors.initials: TA
authors.lastname: Foulk
authors.affiliation: Neonatology, Bnai Zion Medical Center, Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel;
authors.forename: Amir
authors.initials: A
authors.lastname: Kugelman
authors.affiliation: Neonatology, Lady Davis Carmel Medical Center, Haifa, and Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
authors.forename: Ayala
authors.initials: A
authors.lastname: Gover
authors.affiliation: Neonatology, Bnai Zion Medical Center, Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel;
authors.forename: Irit
authors.initials: I
authors.lastname: Shoris
authors.affiliation: Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;
authors.forename: Kinneret S
authors.initials: KS
authors.lastname: Riskin
authors.affiliation: Recanati School of Business, Faculty of Management, and.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Bamberger
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003299:Cooperative Behavior; D020345:Enterocolitis, Necrotizing / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D015931:Intensive Care, Neonatal / Q000523:psychology*; D007400:Interprofessional Relations; D008875:Middle Aged; D010348:Patient Care Team; D000066908:Simulation Training; D012919:Social Behavior