On the one hand, they have to complete and pass the internships and, on the other hand, they are evaluated by HCPs. Students are, to a certain degree, in a bind. However, it is also known that students diminish their role during internships to that of being “just a student”. It is obvious that courage is needed to speak up as it demands the readiness to stand up and to do the right thing at the right time.
A nursing study also showed that during internships students were frequently asked to condone poor practice. Reasons for not speaking up amongst students had been reluctance to question senior staff, unwillingness to interrupt and embarrassment. In 2012 a study in Australia revealed that more than 80% of students were willing to speak up towards others students, however, this number decreased for those who were willing to do so to HCPs. As medical students have to attend several clinical internships in their academic career, they become automatically junior members of care teams and may therefore also play an important role in supporting patient safety. Within our academic teaching hospital, more than 7.000 employees care for patients and more than 3.000 employees are responsible for science and teaching. This HCPs’ silence or withholding voice may have many reasons and the existence of steep hierarchies within HCPs may be the most dominant.
More than half of HCPs perceived specific concerns about patient safety at least once in the last four weeks, however more than 40% remained silent in a critical situation. However, withholding voice is common and was confirmed recently within our university hospital. Speaking up by HCPs to their colleagues is increasingly acknowledged as an important way to reduce risks. Effective teamwork and non-technical skills are essential for the reduction of medical errors.
Speaking up can be defined as assertive communication of quality and patient safety concerns by a team member through information, questions, or opinions in situations where clinical rules are neglected, forgotten or even unknown by a healthcare professional (HCP) in order to avoid patient harm.