RT Journal Article SR Electronic T1 Speaking up about traditional and professionalism-related patient safety threats: a national survey of interns and residents JF BMJ Quality & Safety JO BMJ Qual Saf FD BMJ Publishing Group Ltd SP 869 OP 880 DO 10.1136/bmjqs-2016-006284 VO 26 IS 11 A1 William Martinez A1 Lisa Soleymani Lehmann A1 Eric J Thomas A1 Jason M Etchegaray A1 Julia T Shelburne A1 Gerald B Hickson A1 Donald W Brady A1 Anneliese M Schleyer A1 Jennifer A Best A1 Natalie B May A1 Sigall K Bell YR 2017 UL http://qualitysafety.bmj.com/content/26/11/869.abstract AB Background Open communication between healthcare professionals about care concerns, also known as ‘speaking up’, is essential to patient safety.Objective Compare interns' and residents' experiences, attitudes and factors associated with speaking up about traditional versus professionalism-related safety threats.Design Anonymous, cross-sectional survey.Setting Six US academic medical centres, 2013–2014.Participants 1800 medical and surgical interns and residents (47% responded).Measurements Attitudes about, barriers and facilitators for, and self-reported experience with speaking up. Likelihood of speaking up and the potential for patient harm in two vignettes. Safety Attitude Questionnaire (SAQ) teamwork and safety scales; and Speaking Up Climate for Patient Safety (SUC-Safe) and Speaking Up Climate for Professionalism (SUC-Prof) scales.Results Respondents more commonly observed unprofessional behaviour (75%, 628/837) than traditional safety threats (49%, 410/837); p<0.001, but reported speaking up about unprofessional behaviour less commonly (46%, 287/628 vs 71%, 291/410; p<0.001). Respondents more commonly reported fear of conflict as a barrier to speaking up about unprofessional behaviour compared with traditional safety threats (58%, 482/837 vs 42%, 348/837; p<0.001). Respondents were also less likely to speak up to an attending physician in the professionalism vignette than the traditional safety vignette, even when they perceived high potential patient harm (20%, 49/251 vs 71%, 179/251; p<0.001). Positive perceptions of SAQ teamwork climate and SUC-Safe were independently associated with speaking up in the traditional safety vignette (OR 1.90, 99% CI 1.36 to 2.66 and 1.46, 1.02 to 2.09, respectively), while only a positive perception of SUC-Prof was associated with speaking up in the professionalism vignette (1.76, 1.23 to 2.50).Conclusions Interns and residents commonly observed unprofessional behaviour yet were less likely to speak up about it compared with traditional safety threats even when they perceived high potential patient harm. Measuring SUC-Safe, and particularly SUC-Prof, may fill an existing gap in safety culture assessment.