A behavioural study of obedience in health professional students

Abstract

Interprofessional Education and Collaborative Practice (IPECP) is a field of study suggested to improve team functioning and patient safety. However, even interprofessional teams are susceptible to group pressures which may inhibit speaking up (positive deviance). Obedience is one group pressure that can inhibit positive deviance leading to negative patient outcomes. To examine the influence of obedience to authority in an interprofessional setting, an experimental simulated clinical scenario was conducted with Respiratory Therapy (RT) (n = 40) and Advanced Care Paramedic (ACP) (n = 20) students. In an airway management scenario, it was necessary for students to challenge an authority, a senior anesthesiologist, to prevent patient harm. In a 2 × 2 design cognitive load and an interventional writing task designed to increase positive deviance were tested. The effect of individual characteristics, including Moral Foundations, and displacement of responsibility were also examined. There was a significant effect for profession and cognitive load: RT students demonstrated lower levels of positive deviance in the low cognitive load scenario than students in other conditions. The writing task did not have a significant effect on RT or ACP students’ behaviour. The influence of Moral Foundations differed from expectations, In Group Loyalty was selected as a negative predictor of positive deviance while Respect for Authority was not. Displacement of responsibility was influential for some participants thought not for all. Other individual variables were identified for further investigation. Observational analysis of the simulation videos was conducted to obtain further insight into student behaviour in a compliance scenario. Individual differences, including experience, should be considered when providing education and training for positive deviance. Simulation provides an ideal setting to use compliance scenarios to train for positive deviance and for experimentation to study interprofessional team behaviour.

Integrating Virtual Simulation with Course Curriculum to Improve Patient Advocacy through Speaking Up

“…Facilitators had the discretion to end the simulation early if the participant was not taking any action. The scenario was identical to the one used by Violato et al (Violato, Witschen, et al, 2021) (see Figure 3 and supplemental material). A CAE Healthcare iStan Mannequin (CAE Healthcare, 2017) was used.…”

“…A successful challenge was de ned as the participant making an explicit, direct, and persistent challenge to the doctor that removes ambiguity. Challenges must be explicit and direct to elicit change effectively (Bandura, 1999;Violato, Witschen, et al, 2021). A strong challenge could comprise, though was not limited to, statements such as what is occurring is unsafe or is a safety issue, making a statement about stopping, or indicating they would call for help (Violato, Witschen, et al, 2021).…”

“…Challenges must be explicit and direct to elicit change effectively (Bandura, 1999;Violato, Witschen, et al, 2021). A strong challenge could comprise, though was not limited to, statements such as what is occurring is unsafe or is a safety issue, making a statement about stopping, or indicating they would call for help (Violato, Witschen, et al, 2021). As a backup in the case of lost audio or video, the facilitators scored successful challenges during the simulation.…”

A longitudinal study on the impact of simulation on positive deviance through speaking up

“…During the 2019 winter semester, a simulation study was run with Respiratory Therapy (RT, n = 40) and Advanced Care Paramedic (ACP, n = 20) students to examine obedience to authority and PD/SU [ 7 , 8 ]. The simulation involved an airway management scenario where it was necessary to challenge a physician to prevent a negative patient outcome.…”

“…The scenario ended when participants made a strong persistent challenge or if participants did not escalate the challenge. Thirty-six per cent of students did not successfully challenge the physician [ 7 ].…”