Factors associated with medical students speaking-up about medical errors: A cross-sectional study

Abstract

Background

Training medical students to speak up when they witness a potential error is an important competency for patient safety, but details regarding the barriers that prevent medical students from effectively communicating are lacking. Therefore, this study aimed at exploring the factors affecting medical students’ willingness to speak up for patient safety when a medical error was observed.

Methods

This is a cross-sectional study at a medical university in Taiwan, and 151 medical students in clinical clerkship completed a survey including demographic characteristics, conflict of interests/social relationship, personal capability, and personality and characteristics of senior staff domains. Data were analyzed using t-test.

Results

Three of five items in the conflict of interests/social relationship domain showed statistically significant importance, including ‘I am afraid of being punished’ (Mean difference, MD = 0.37; p < 0.01), ‘I do not want to break unspoken rules’ (MD = 0.55; p < 0.01), and ‘I do not want to have bad team relationship’ (MD = 0.58; p < 0.01). Two items (perception of knowledge/understanding and communication skills) in the personal capability domain were significantly important to speaking up. Six of 10 items in personality and characteristics of senior staff domain were rated significantly important in deciding to speak up. The top three factors of them were senior personnel with ‘Grumpy’ personality (MD = 1.20; p < 0.01), ‘hierarchy gap’ (MD = 1.12; p < 0.01), and senior personnel with ‘Stubborn’ personality (MD = 1.06; p < 0.01).

Conclusion

Our findings demonstrated medical students’ perspectives on barriers to speaking up in the event of medical error. Some factors related to characteristics of senior staff could compromise medical students’ ability to speak up in the event of medical error. These results might be important for medical educators in designing personalized educational activities related to medical students’ ability to speak up for patient safety.

Keywords:

• General
• curriculum
• undergraduate

Disclosure statement

Yi-Chun Chen, S. Barry Issenberg, Zachary Issenberg, Hui-Wen Chen, Yi-No Kang, and Jen-Chieh Wu declare that they have nothing to disclose regarding financial or non-financial conflicts of interest to this manuscript.

Authors contributions

Yi-Chun Chen, Yi-No Kang, and Jen-Chieh Wu: conceptualization. Yi-Chun Chen, Hui-Wen Chen, and Jen-Chieh Wu: Hui-Wen Chen: formal analysis. Yi-Chun Chen, Yi-No Kang, and Jen-Chieh Wu: investigation. Yi-No Kang: methodology. S. Barry Issenberg and Jen-Chieh Wu: supervision. Yi-Chun Chen and Jen-Chieh Wu: writing – original draft. S. Barry Issenberg, Zachary Issenberg, Hui-Wen Chen, and Yi-No Kang: writing – review & editing.

Data availability statement

Data in this study is available to other researchers upon reasonable request.

Additional information

Notes on contributors

Yi-Chun Chen

Yi-Chun Chen, M.D, Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan, R.O.C.

S. Barry Issenberg

S. Barry Issenberg, M.D., Prof. Medicine and Michael S. Gordon Chair of Medical Education, University of Miami Miller School of Medicine, FL. Nursing and Health in Medical Education, University of Miami Miller School of Medicine, FL. Continuing Medical Education, University of Miami Miller School of Medicine, FL. Simulation and Innovation in Medical Education, University of Miami Miller School of Medicine, FL.

Zachary Issenberg

Zachary Issenberg, MFA, Columbia University, NY.

Hui-Wen Chen

Hui-Wen Chen, M.S. School of Nursing, National Yang-Ming University, Taipei, Taiwan, R.O.C.

Yi-No Kang

Yi-No Kang, Consultant, M.A. Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, R.O.C. Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan, R.O.C. Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, R.O.C. Institute of Health Policy & Management, College of Public Health, National Taiwan University Taipei, Taiwan, R.O.C.

Jen-Chieh Wu

Jen-Chieh Wu, M.D. Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan, R.O.C., Department of Education, Taipei Medical University Hospital, Taipei, Taiwan, R.O.C., Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, R.O.C.