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What became of the ‘eyes and the ears’?: exploring the challenges to reporting poor quality of care among trainee medical staff
  1. Philip Berry
  1. Gastroenterology, Hepatology and Nutrition, Guy's and St Thomas' Hospitals NHS Trust, London, UK
  1. Correspondence to Dr Philip Berry, Department of Gastroenterology, Hepatology and Nutrition, Guy's and St Thomas' Hospitals NHS Foundation Trust, London SE17EH, UK; philaberry{at}


The importance of trainee medical staff in alerting Trusts to patient safety risks and low-quality care was established by the Francis Report, yet many remain hesitant about speaking up. Known barriers include lack of feedback, sceptical attitudes to the likelihood of change and fear of consequences. The author explores other factors including moral orientation in the workplace, role modelling by senior clinicians, discontinuity, ‘normalisation of deviance’, human reactions to burnout/moral injury, loyalty and the spectrum of motivation. The issues of absent feedback and fear are discussed in detail. Challenges met by those receiving reports are also described, such as how to collate soft intelligence, putting concerns into context (the ‘bigger picture’) and stewardship of resources. Initiatives to encourage reporting of trainees’ concerns such as speak up guardians, ‘Speak Up for Safety’ campaign and simulation training are described. A proposal to embed proactive intelligence-gathering arrangements is presented.

  • medical ethics
  • health & safety
  • medical education & training

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  • Twitter @philaberry

  • Contributors PB conceived and wrote the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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

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