{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T01:32:12Z","timestamp":1788485532194,"version":"build-2803163510"},"reference-count":21,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,5,10]],"date-time":"2024-05-10T00:00:00Z","timestamp":1715299200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,5,10]],"date-time":"2024-05-10T00:00:00Z","timestamp":1715299200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100018828","name":"Intuitive Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100018828","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010564","name":"Academic Medical Organization of Southwestern Ontario","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010564","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100022104","name":"Schulich School of Medicine and Dentistry, Western University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100022104","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Department of Obstetrics and Gynecology, Western University"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Adv Simul"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Although speaking up is lauded as a critical patient safety strategy, it remains exceptionally challenging for team members to enact. Existing efforts to address the problem of silence among interprofessional teams involve training low-authority members to use direct language and unambiguous challenge scripts. The role or value of indirect communication in preventing medical error remains largely unexplored despite its pervasiveness among interprofessional teams. This study explores the role of indirect challenges in the face of medical error and professionalism lapses.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Obstetricians at one academic center participated in an interprofessional simulation as a partial actor. Thirteen iterations were completed with 39 participants (13 obstetrician consultants, 11 obstetric residents, 2 family medicine consultants, 5 midwives, and 8 obstetrical nurses). Thirty participants completed a subsequent semi-structured interview. Five challenge moments were scripted for the obstetrician involving deliberate clinical judgment errors or professionalism infractions. Other participants were unaware of the obstetrician\u2019s partial actor role. Scenarios were videotaped; debriefs and interviews were audio-recorded and transcribed verbatim and analyzed using a constructivist qualitative approach.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Low-authority team members primarily relied on indirect challenge scripts to promote patient safety during simulation. Faculty participants were highly receptive to indirect challenges from low-authority team members, particularly in front of awake patients. In the context of obstetric care, direct challenges were actually viewed by participants as threatening to patient trust and disruptive to the interprofessional team. Instead of exclusively focusing our efforts on encouraging low-authority team members to speak up through direct challenges, it may be fruitful to expand our attention toward teaching faculty to identify, listen for, and respond to the indirect, subtle challenges that are already prolific among interprofessional teams.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s41077-024-00293-4","type":"journal-article","created":{"date-parts":[[2024,5,10]],"date-time":"2024-05-10T10:01:54Z","timestamp":1715335314000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["\u201cThe patient is awake and we need to stay calm\u201d: reconsidering indirect communication in the face of medical error and professionalism lapses"],"prefix":"10.1186","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0562-5045","authenticated-orcid":false,"given":"Taryn","family":"Taylor","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Columbus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harrison","family":"Banner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natashia","family":"Seemann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trevor Hines","family":"Duncliffe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachael","family":"Pack","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,5,10]]},"reference":[{"issue":"8","key":"293_CR1","doi-asserted-by":"publisher","first-page":"e814","DOI":"10.1097\/CCM.0000000000002450","volume":"45","author":"Z Friedman","year":"2017","unstructured":"Friedman Z, Perelman V, McLuckie D, Andrews M, Noble LM, Malavade A, Bould MD. Challenging authority during an emergency\u2014the effect of a teaching intervention. Crit Care Med. 2017;45(8):e814\u201320.","journal-title":"Crit Care Med"},{"issue":"6","key":"293_CR2","doi-asserted-by":"publisher","first-page":"576","DOI":"10.1007\/s12630-015-0364-5","volume":"62","author":"MD Bould","year":"2015","unstructured":"Bould MD, Sutherland S, Sydor DT, Naik V, Friedman Z. Residents\u2019 reluctance to challenge negative hierarchy in the operating room: a qualitative study. Can J Anesth. 2015;62(6):576\u201386.","journal-title":"Can J Anesth"},{"issue":"2","key":"293_CR3","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1097\/SIH.0b013e31818cffd3","volume":"4","author":"MC Pian-Smith","year":"2009","unstructured":"Pian-Smith MC, Simon R, Minehart RD, Podraza M, Rudolph J, Walzer T, Raemer D. Teaching residents the two-challenge rule: a simulation-based approach to improve education and patient safety. 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