Taylor, T., Columbus, L., Banner, H. et al. “The patient is awake and we need to stay calm”: reconsidering indirect communication in the face of medical error and professionalism lapses. Adv Simul 9, 17 (2024). https://doi.org/10.1186/s41077-024-00293-4 

We know that speaking up is good for patient safety, but hard to do, and that training may not be effective in altering behaviour in the face of hierarchy and cultural barriers. In this article, Taryn Taylor and her research team suggest that indirect, subtle challenges are less well understood and may have more value than we’ve appreciated. And maybe patent presence might be an important influence on this behaviour? 

Taryn Taylor is an OBGYN and simulation practitioner and researcher. She is assistant professor of Obstetrics & Gynaecology at Western University in London Ontario Canada, a graduate of the Uni Ottawa Simulation Fellowship, and has a PhD in Health Professions Education from Maastricht University. As a researcher, most recently she’s focused on using sociological fidelity in simulation to explore the complex social dynamics in healthcare teams that impact care delivery and patient outcomes. 

The article is a methodological masterclass, showing us how to create ‘sociologic fidelity’ to allow research of these complex relational phenomena and how to use this ‘simulation primed elicitation approach’ to collect data. 

The findings are unsettling but important! Even in the face of error and lapses in patient safety, the communication remained indirect, subtle, and sometimes non-verbal. Study subjects described quite problematic assumptions about their teams, that we must recognise to advance work in this area. 

Taryn helps us get the story behind the study and we reflect on how this might translate to a broader educational agenda. 

Happy listening! 

vb