Table 2

 Percentage of US and Japanese residents who identified each issue as important in making a decision to challenge and not to challenge their seniors

Scenario: Suppose you are in the OR and doing a difficult operation with a senior surgeon who is concentrating deeply on the procedure. You notice that the senior surgeon has done something that might lead to a serious complication for the patient but the surgeon either does not seem to be aware of the problem or, in your view, has made a poor judgment.
Question (1) You are considering speaking up and ultimately choose to CHALLENGE the senior surgeon about the problem. How do these issues affect your decision to challenge?
Importance of the itemsVery unimportantUnimportantNeutralImportantVery importantp value*
*p values calculated by Wilcoxon rank sum test between the US and Japan.
†Statistically significant difference at p<0.05 level.
Penalty/repercussionUS37.615.262.112.1<0.01†
JP5.217.232.836.28.6
Reward/prestigeUS6.130.330.328.84.50.04†
JP01936.234.510.3
Social acceptance or rejectionUS1.518.231.843.94.50.02+
JP5.26.922.443.122.4
Knowledge/experience/understandingUS307.641.347.60.13
JP01.717.246.634.5
Image/self-worth/prideUS018.52047.713.80.02†
JP10.38.646.627.66.9
Teamwork/professionalism/hierarchyUS1.54.615.450290.09
JP1.76.927.643.120.7
Communication skillsUS1.59.29.252.327.70.03†
JP001929.351.7
Relationship/personality of superiorsUS1.83.614.556.423.60.16
JP01.717.239.741.4
Question (2) You are considering speaking up and ultimately you choose NOT TO CHALLENGE the senior surgeon about the problem. How important are these issues in affecting your decision not to challenge?
Penalty/repercussionUS3.117.27.859.412.50.04†
JP8.815.822.840.412.3
Reward/prestigeUS10.942.217.229.700.38
JP1422.833.321.18.8
Social acceptance or rejectionUS4.717.220.351.66.30.03†
JP3.55.319.349.122.8
Knowledge/experience/understandingUS6.312.71942.9190.06
JP3.55.317.540.433.3
Image/self-worth/prideUS9.522.228.631.77.90.87
JP10.51435.126.314
Teamwork/professionalism/hierarchyUS3.26.511.367.711.30.31
JP75.321.150.915.8
Communication skillsUS1.62119.446.811.30.06
JP1.85.328.133.331.6
Relationship/personality of superiorsUS1.85.52041.830.90.77
JP3.55.317.538.635.1