A qualitative interview study of medical residents’ emotions in speaking up on medical rounds

Speaking up during inpatient medical rounds involves medical trainees voicing ideas, concerns, or information when unprompted for the benefit of patient care and education. Medical residents encounter a unique set of considerations regarding the decision to speak up during rounds. However, little is known about the role of trainees’ emotions in speaking up in this context. The objective of this study was to explore the role of emotions in speaking up behaviours among medical residents during inpatient medical rounds. We conducted interviews with 21 medical residents inquiring about perspectives on speaking up. We developed a framework for classifying emotions, which consisted of valence (positive or negative), moral emotions (condemning, self-conscious, suffering, or praising), and non-moral emotions (fear, love, schadenfreude). Interview transcripts were deductively coded and analyzed to identify patterns of emotions and their drivers in the context of speaking up during rounds. Medical residents shared a range of positively- and negatively-valenced emotions in association with speaking up during rounds. We identified five types of emotions in speaking up during rounds that were commonly experienced by residents: praising emotions, self-conscious emotions, condemning emotions, suffering emotions, and fear. Specific drivers of these emotions were identified and classified into workplace, relational, patient-related, or personal factors. Ultimately, we found that medical residents experience both positive and negative emotions that influence speaking up behaviours during inpatient rounds. Further exploration into the role that emotions play in speaking up on inpatient medical rounds may provide valuable insights for medical education research and teaching practices.