Poor resident-attending intraoperative communication may compromise patient safety

Prior research suggests that hierarchy in medicine may impact communication and patient safety. This study examined the factors that influence surgical trainees in expressing their opinion in the operating room and the consequences this might have on patient safety.

An anonymous survey of general surgery, gynecology, and orthopedic surgery residents and attendings was conducted at a teaching institution in 2010. Separate surveys were used for attendings and for trainees consisting of 26 and 27 questions, respectively, with 17 questions in common. The surveys assessed whether the surgical hierarchy interfered with the residents voicing concerns about patient safety. Survey data was compiled, and χ2, Fisher exact tests, and the Wilcoxon rank sum test were used depending on the normality of the data.

Thirty-eight trainees and 23 attendings participated in the survey; 74%-78% of trainees and attendings recalled an incident where the trainee spoke up and prevented an adverse event. While all attendings reported that they encourage residents to question their intraoperative decision making, only 55% of residents agreed (P<0.01). Residents indicated that they were more likely to voice their opinion with some attendings than with others based on their personality. Both groups agreed that the hierarchical structure of general surgical residency is necessary.

Our findings indicate that resident attending intraoperative communication can prevent adverse patient events. Trainees often feel impaired in voicing their concerns to their attendings. Strategies that improve resident attending communication intraoperatively are needed as they are likely to enhance patient safety.