A behavioural study of obedience in health professional students

• Published in: Advances in health sciences education : theory and practice 2022-05, Vol.27 (2), p.293-321
• Main Authors: Violato, Efrem, Witschen, Brian, Violato, Emilio, King, Sharla
• Format: Article
• Language: English
• Subjects: Advocacy; Allied Health Occupations Education; Allied Health Personnel; Allied Health Personnel - education; Barriers; Clinical outcomes; Cognitive Ability; Cognitive load; Collaboration; Communication; Compliance; Compliance (Psychology); Conformity; Cooperative Behavior; Education; Group Dynamics; Health Personnel - education; Humans; Individual Characteristics; Individual Differences; Inhibition; Interprofessional Education; Interprofessional Relations; Interprofessional Relationship; Medical Education; Medical Students; Patient Care Team; Patient safety; Patients; Peer Influence; Predictor Variables; Professional Education; Professions; Responsibility; Safety; Student Behavior; Students; Students, Nursing - psychology; Teams; Teamwork; Therapy
• ISSN: 1382-4996; 1573-1677; 1573-1677
• DOI: 10.1007/s10459-021-10085-4

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.