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Deliberate practices of speaking up and responding skills: the Speak-PREP e-learning module for healthcare professionals
  1. Megan M Gray1,
  2. Elizabeth Rosenman2,
  3. Jennifer A Best2,
  4. Barbara Menzel3,
  5. Gabrielle Berger2,
  6. Ross Ehrmantraut4,
  7. Pete Napolitano5,
  8. Rachel Umoren1,
  9. Sara Kim6
  1. 1 Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
  2. 2 Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
  3. 3 B.S., M.C. Dispute Resolution, Dispute Resolution Center of Snohomish, Everett, Washington, USA
  4. 4 Department of Medicine, WISH, University of Washington School of Medicine, Seattle, Washington, USA
  5. 5 Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA
  6. 6 Department of Surgery, University of Washington, Seattle, Washington, USA
  1. Correspondence to Dr Megan M Gray, Pediatrics, University of Washington School of Medicine, Seattle, WA 98105, USA; graym1{at}


Purpose Speaking up and responding to others’ concerns promotes patient safety. We describe health professionals’ utilisation of these important skills.

Method We developed an interactive e-learning module, Speak-PREP, to train healthcare professionals in speaking up and responding strategies. Participants completed interactive video-based exercises that engaged them with entering speaking up and responding statements, augmenting strategies from a list of prompting phrases and responding to a pushback. We report strategy utilisation.

Results A total of 101 health professionals completed Speak-PREP training. Most frequently used speaking up strategies were: brainstorming to explore solutions (50%), showing consideration of others (45%) and encouraging others’ opinions through invitations (43%). Responding strategies included reflecting the concern expressed by colleagues, discussing next steps and expressing gratitude (70%, 67% and 50%, respectively). When prompted, participants augmented their statements with reframing concerns, asking questions to deepen understanding, using how or what to start questions and expressing curiosity (p<0.00001, p=0.003, p=0.0002 and p<0.0001, respectively). Pushbacks lead to increased use of reflecting the concern and decreasing consideration, curiosity, empathy, expressing gratitude and encouraging others’ opinions (p<0.05 for all).

Conclusions The Speak-PREP module targeted deliberate practice in speaking up and responding skills. Future work should examine the application of these strategies in the clinical environment.

  • patient safety
  • communication
  • behaviour
  • learning
  • strategy

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  • Contributors MMG, JAB, PN, RU, SK and RE contributed to initial study design, educational materials review and writing. MMG oversaw data collection and analysis and took a lead in drafting. ER and GB assisted with data interpretation and writing. BM assisted with content expertise and educational materials writing.

  • Funding This work was funded by the University of Washington Patient Safety Innovations Program (award number PSIP4).

  • Disclaimer The funders had no role in the study outside of grant review and funding approval.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.