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0188 Speak Up! What Are The Barriers To Challenging Seniors?
  1. Tanja Beament,
  2. Simon Mercer
  1. Centre for Simulation and Patient Safety, Liverpool, Merseyside, UK


Background Recent high-profile cases of medical errors within a culture, where individuals felt unable to speak up, suggest that failure to challenge erroneous decisions contributes to patient morbidity and mortality.1 “Responsible” followers are team-members with interpersonal skills, which allow for decisions of leaders to be challenged without contributing to a defensive or risk adverse culture.2 It is crucial to identify those effective interpersonal skills and possible barriers to challenging seniors. Previous work suggests that simulation sessions incorporating erroneous decisions, can promote appropriate leadership challenges.3 This project attempts to explore reasons for failure in a safe simulation environment and identify actual or perceived barriers to challenging senior anaesthetists to guide further medical education.

Methodology 20 CT1/2 anaesthetic trainee volunteers from our deanery will be invited to participate in a high-fidelity simulation scenario. Candidates will be randomly allocated to one of 2 standardised scenarios (scenario 1: surgeon requesting administration of wrong antibiotic triggering anaphylaxis. Scenario 2: consultant anaesthetist fixated on intubation despite patient desaturation). Scenarios will be videoed and watched during debriefing and each candidate asked to “think aloud”4 to identify behaviours and "barrier themes". The debrief conversation will be transcribed, coded and analysed qualitatively using NVivo software. A phenomenological approach to data analysis, contrasting emerging themes with a control group will be adopted. Quantitative measurements will be undertaken to allow for triangulation.

Results and potential impact Using a mixed strategy, we will explore the dynamics of the trainee-supervisor relationship, and reflect on its implications to the timely delivery of safe care. Identifying possible barriers and underlying frames for trainees’ challenging behaviours and time-lag for challenging seniors can suggest effective strategies to challenge erroneous decisions.

This research will be advanced further as a team-skills workshop, where human factors, CRM and successful techniques for challenging can be developed.


  1. Belyansky I, Martin TR, Prabhu AS. Poor Resident Attending Intraoperative Communication May Compromise Patient Safety. J Surg Res 2011;171:386–94

  2. Grint K, Holt C. Followership in the NHS. London, UK: King’s Fund. 2011

  3. Moneypenny MJ, Guha A, Mercer SJ, et al. Don’t follow your leader: Challenging erroneous decisions. British Journal of Hospital Medicine 2013;pp. 1–8

  4. Fonteyn ME, Kuipers B, Grobe SJ. A Description of Think Aloud Method and Protocol Analysis. Qualitative Health Research 1993;3(4):430–41

  • Category: Course or curriculum evaluation/innovation/integration

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