How can surgeons promote learner/patient safety threefold?

A reader sent me an article that I really enjoyed over the weekend.  Not only was it focused on Surgeons, a group of colleagues I have tremendous respect for, it also focused on an eloquent and simple strategy to promote learner and patient safety.

The intervention was simple.  From the paper:

"A randomized clinical trial in which medical students (n=55) were randomized to an “encouraged” (E, n=28) or “discouraged” (D, n=27) group. Participants underwent personality tests to assess decision-making styles, and were then trained on basic tasks (“burn” then “cut”) on a laparoscopic surgery simulator. After randomization students assisted at a simulated laparoscopic salpingectomy. The senior surgeon used either an “encourage” (E) or a “discourage” (D) script (e.g.: E: “Your opinion is important.” D: “Do what I say. Save questions for next time.”). Otherwise, the surgery was conducted identically. Subsequently a surgical mistake was made by the senior surgeon who instructed students to cut without burning. Students were considered to have spoken up if they questioned the instruction and did not cut."

The outcome?  Equally simple but of a profound impact:

"The students in the encouraged group were significantly more likely to speak up (23/28, 82% vs. 8/27, 30%, P<0.001). "

This is exciting - a supervising surgeon can increase - almost threefold - the motivation and ability of a learner to speak up in a crucial moment by doing nothing more than a singular encouraging statement.