Iatrogenesis often results from performance deficiencies among medical team members. Team-targeted rudeness may underlie such performance deficiencies, with individuals exposed to rude behavior being less helpful and cooperative. Our objective was to explore the impact of rudeness on the performance of medical teams.
Twenty-four NICU teams participated in a training simulation involving a preterm infant whose condition acutely deteriorated due to necrotizing enterocolitis. Participants were informed that a foreign expert on team reflexivity in medicine would observe them. Teams were randomly assigned to either exposure to rudeness (in which the expert’s comments included mildly rude statements completely unrelated to the teams’ performance) or control (neutral comments). The videotaped simulation sessions were evaluated by 3 independent judges (blinded to team exposure) who used structured questionnaires to assess team performance, information-sharing, and help-seeking.
The composite diagnostic and procedural performance scores were lower for members of teams exposed to rudeness than to members of the control teams (2.6 vs 3.2 [P = .005] and 2.8 vs 3.3 [P = .008], respectively). Rudeness alone explained nearly 12% of the variance in diagnostic and procedural performance. A model specifying information-sharing and help-seeking as mediators linking rudeness to team performance explained an even greater portion of the variance in diagnostic and procedural performance (R2 = 52.3 and 42.7, respectively).
Rudeness had adverse consequences on the diagnostic and procedural performance of the NICU team members. Information-sharing mediated the adverse effect of rudeness on diagnostic performance, and help-seeking mediated the effect of rudeness on procedural performance.
Comments
Using the term incivility for non-professional behavior across the continuum of medical education
The article by Riskin et al in the September issue of Pediatrics, using a randomized controlled simulation study, makes an important contribution to the literature on incivility in the clinical setting. Based on their work and that of others, I would like to suggest that future articles/studies should all employ the same terminology in this area so as to making searches and accessing references easier. Currently, there are so many terms used in studies, to name a few: bullying, non- professionalism, disrespect, mistreatment, verbal and physical harassment, sexual and gender discrimination, and in the current article, rudeness. An accepted term used in the non-medical literature is incivility, to which the authors refer. The definitionof incivility from a number of sources is a rude, discourteous, unsociable, or impolite attitude or behavior. Some recent articles in Academic Medicine (2104) provide an up-to-date overview of the topic (1-5), which the authors did not cite. This may have been deliberate or an omission in the search engine used in surveying the literature.
1. Dankoski, ME, Bickel, J and Gusic, ME Discussing the undiscussable with the powerful: Why and how faculty must learn to counteract organizational silence Acad Med 2014; 89: 1610-1613
2. Krugman, CD, Jones, MD Jr, and Lowenstein, SR Can we learn civility? Reflections on the challenge of changing culture Acad Med 2014; 89: 1586- 1588
3. Mavis, B, Sousa, A, Lipscomb, W, Rappley, MD Learning about medical student mistreatment from responses to the medical student graduate questionnaire Acad Med 2014; 89: 705-711
4. Cook, AF, Arora, VM, Rasinski, KA, et al The prevalence of medical student mistreatment and its association with burnout Acad Med 2014; 89: 749-754
5. Frais, N, Soobiah, C, Chen, MH Harassement and discrimination in medical training: A systematic review and meta-analysis Acad Med 2014; 89: 817-822
Conflict of Interest:
None declared