Power and conflict: the effect of a superior's interpersonal behaviour on trainees’ ability to challenge authority during a simulated airway emergency

Abstract

Summary A key factor that may contribute to communication failures is status asymmetry between team members. We examined the effect of a consultant anaesthetist's interpersonal behaviour on trainees’ ability to effectively challenge clearly incorrect clinical decisions. Thirty‐four trainees were recruited to participate in a video‐recorded scenario of an airway crisis. They were randomised to a group in which a confederate consultant anaesthetist's interpersonal behaviour was scripted to recreate either a strict/exclusive or an open/inclusive communication dynamic. The scenario allowed trainees four opportunities to challenge clearly wrong decisions. Performances were scored using the modified Advocacy‐Inquiry Score. The highest median (IQR [range]) score was 3.0 (2.2–4.0 [1.0–5.0]) in the exclusive communication group, and 3.5 (3.0–4.5 [2.5–6.0]) in the inclusive communication group (p = 0.06). The study did not show a significant effect of consultant behaviour on trainees’ ability to challenge their superior. It did demonstrate trainees’ inability to challenge their seniors effectively, resulting in critical communication gaps.

Conflict resolution in anaesthesia: systematic review

“…The checking and administrating of blood between both groups (hierarchical and non-hierarchical) were not significant. Similarly, Friedman et al 18 observed that the interpersonal behaviour of the consultant anaesthetist and the resulting speaking up did not significantly impact on trainees’ ability to challenge their superiors during airway crisis.…”

“…The outcomes were trainee anaesthetists’ capability to challenge an unethical decision by their superiors. Friedman et al 18 randomised trainees to scenarios with either a strict/exclusive or open/inclusive communication dynamic to investigate the impact of interpersonal behaviour of consultant anaesthetists on trainee anaesthetists during emergency airway practice. Performances were measured by using the mAIS by independent raters 17 18.…”

‘Help! I need somebody’: getting timely assistance in clinical practice

“…The available evidence suggests that situational awareness improves with experience [13], and that trainees are slower at picking up when things are going wrong [14]. Further, through fear of senior staff, or a desire to practice independently, trainees may delay a call for help [15,16], making a method of communication which minimises further delay essential. These factors also remind us that, for students and trainees, knowing when to call for help and when to try to manage events on their own is a difficult judgement to learn.…”

Hierarchy in critical airway management

“…We have recently conducted a similar pilot study to that reported by Friedman et al [1,2], with the aim of exploring how Core Trainee (CT) anaesthetists (one to two years of anaesthetic experience) challenge a consultant anaesthetist within a fully immersive 'can't intubate, can't ventilate' simulation.…”

“…Recently, Anaesthesia has carried a number of descriptions of chest wall nerve blocks, derived from serratus plane block [1][2][3][4].…”