title: Improving Anesthesiologists' Ability to Speak Up in the Operating Room: A Randomized Controlled Experiment of a Simulation-Based Intervention and a Qualitative Analysis of Hurdles and Enablers.
abstract: OBJECTIVE
  The authors addressed three questions: (1) Would a realistic simulation-based educational intervention improve speaking-up behaviors of practicing nontrainee anesthesiologists? (2) What would those speaking-up behaviors be when the issue emanated from a surgeon, a circulating nurse, or an anesthesiologist colleague? (3) What were the hurdles and enablers to speaking up in those situations?
  
  
  METHODS
  The authors conducted a simulation-based randomized controlled experiment from March 2008-February 2011 at the Center for Medical Simulation, Boston, Massachusetts. During a mandatory crisis management course for practicing nontrainee anesthesiologists from five Boston institutions, a 50-minute workshop on speaking up was conducted for intervention (n = 35) and control (n = 36) groups before or after, respectively, an experimental scenario with three events. The authors analyzed videos of the experimental scenarios and debriefing sessions.
  
  
  RESULTS
  No statistically significant differences between the intervention and control group subjects with respect to speaking-up actions were observed in any of the three events. The five most frequently mentioned hurdles to speaking up were uncertainty about the issue, stereotypes of others on the team, familiarity with the individual, respect for experience, and the repercussion expected. The five most frequently mentioned enablers were realizing the speaking-up problem, having a speaking-up rubric, certainty about the consequences of speaking up, familiarity with the individual, and having a second opinion or getting help.
  
  
  CONCLUSIONS
  An educational intervention alone was ineffective in improving the speaking-up behaviors of practicing nontrainee anesthesiologists. Other measures to change speaking-up behaviors could be implemented and might improve patient safety.
authors.affiliation: D.B. Raemer is associate professor of anaesthesia, Harvard Medical School, faculty member, Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, and senior director of clinical programs, Center for Medical Simulation, Boston, Massachusetts. M. Kolbe is faculty member, Organization, Work and Technology Group, Department of Management, Technology and Economics, ETH Zurich, and director, Simulation Center, University Hospital Zurich, Zurich, Switzerland. R.D. Minehart is assistant professor of anaesthesia, Harvard Medical School, faculty member, Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, and teaching faculty, Center for Medical Simulation, Boston, Massachusetts. J.W. Rudolph is assistant clinical professor of anaesthesia, Harvard Medical School, faculty member, Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, and director, Institute for Medical Simulation, Center for Medical Simulation, Boston, Massachusetts. M.C.M. Pian-Smith is associate professor of anaesthesia, Harvard Medical School, faculty member, Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, and teaching faculty, Center for Medical Simulation, Boston, Massachusetts.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Raemer
authors.forename: Michaela
authors.initials: M
authors.lastname: Kolbe
authors.forename: Rebecca D
authors.initials: RD
authors.lastname: Minehart
authors.forename: Jenny W
authors.initials: JW
authors.lastname: Rudolph
authors.forename: May C M
authors.initials: MC
authors.lastname: Pian-Smith
mesh_terms: D000776:Anesthesiology / Q000193:education*; D001900:Boston; D002983:Clinical Competence; D003142:Communication; D003144:Communication Barriers; D006801:Humans; D033183:Interdisciplinary Communication; D009873:Operating Rooms; D015279:Organizational Culture; D061214:Patient Safety; D010815:Physician Impairment; D036301:Qualitative Research; D000066908:Simulation Training / Q000379:methods*; D013240:Stereotyping; D035501:Uncertainty; D014743:Videotape Recording