• Zeev Friedman, Vsovolod Perelman, Duncan McLuckie, Meghan Andrews, Laura M K Noble, Archana Malavade, and M Dylan Bould.
• 1Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.2Department of Anesthesiology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada.3Department of Anesthesiology, The Montfort Hospital, Ottawa, ON, Canada.4Department of Anesthesia, Mount Sinai Hospital, Toronto, ON, Canada.
• Crit. Care Med. 2017 Aug 1; 45 (8): e814-e820.

ObjectivesPrevious research has shown that residents were unable to effectively challenge a superior's wrong decision during a crisis situation, a problem that can contribute to preventable mortality. We aimed to assess whether a teaching intervention enabled residents to effectively challenge clearly wrong clinical decisions made by their staff.Subjects And InterventionFollowing ethics board approval, second year residents were randomized to a teaching intervention targeting cognitive skills needed to challenge a superior's decision, or a control group receiving general crisis management instruction. Two weeks later, subjects participated in a simulated crisis that presented them with opportunities to challenge clearly wrong decisions in a can't-intubate-can't-ventilate scenario. It was only disclosed that the staff was a confederate during the debriefing. Performances were video recorded and assessed by two raters blinded to group allocation using the modified Advocacy-Inquiry Score.Measurements And Main ResultsFifty residents completed the study. The interrater reliability of the modified Advocacy-Inquiry Scores (intraclass correlation coefficient = 0.87) was excellent. The median (interquartile range) best modified Advocacy-Inquiry Score was significantly better in the intervention group 5.0 (4.50-5.62 [4-6]) than in the control group 3.5 (3.0-4.75 [3-6]) (p < 0.001).ConclusionsA short targeted teaching intervention was effective in significantly improving residents' ability to challenge a wrong decision by a superior. This suggests that residents are not given the proper tools to challenge authority during a life-threatening crisis situation. This educational gap can have significant implications for patients' safety.

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