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Simulated Patient's Perspective on Speaking up about Unprofessional Behavior: "Training the Responding Muscles is Key!"

Marianne Mak-van der Vossen, Walther van Mook, Gerda Croiset, Rashmi Kusurkar

Unprofessional behavior of physicians can put patient safety at risk. At VUmc School of Medical Sciences, Amsterdam, the Netherlands, the workshop ‘Responding to unprofessional behavior of faculty and peers’ has been developed for undergraduate students. As the patient perspective on speaking up behavior is important and currently missing in the literature, two ‘simulated patients’ who participate in this workshop, were interviewed to explore their opinions and experiences. Their perspectives could be helpful to medical educators who want to develop education about speaking up about unprofessional behavior.

In the interviews, both simulated patients expressed that they expect physicians to speak up about unprofessional behavior of colleagues. Consequently, they expect students to develop the skills to do so. In the workshops, they experience that students encounter difficulties to bring their intended message across clearly without offending the person addressed. They state that practice is needed to acquire the skill of responding to unprofessional behaviour. The simulated patients are of the opinion that not only students, but also educators have to learn how to handle unprofessional behavior. By role modelling to their students an open, supportive way of responding, teachers can help to create a culture in which it is accepted to address behaviors among each other.

Concluding, simulated patients explicitly support the assumptions that are made in the medical education literature about addressing unprofessional behavior: all involved in health health care —students, educators, physicians and patients— have a responsibility to change the atmosphere in medicine towards an open supportive culture in which it is acknowledged that lapses in professionalism can occur in people with good intentions. By openly discussing such lapses, we can put a step towards changing the culture in health care.