Residents' reluctance to challenge negative hierarchy in the operating room: a qualitative study

Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie
M D BouldZ Friedman

Abstract

Our aim was to clarify how hierarchy influences residents' reluctance to challenge authority with respect to clearly erroneous medical decision-making. After research ethics approval, we recruited 44 anesthesia residents for a high-fidelity simulation scenario at two Ontario universities. During the scenario, an actor, whom the residents were told was an actual new staff anesthesiologist at their university, asked the trainees to give blood to a Jehovah's Witness in contradiction to the patient's explicitly stated wishes. Following the case, the trainees were debriefed and were interviewed for 30-40 min. The interviews were audio recorded and transcribed verbatim, and the text was coded using a qualitative approach informed by grounded theory. Qualitative analysis of the participants' interviews yielded rich descriptive accounts of hierarchical influences often characterized by fear and intimidation. Residents spoke about their coping strategies, which included adaptability, avoiding conflict, using inquiry as a method for patient advocacy, and relying on a diffusion of responsibility within the larger operating room team. Study results showed that hierarchy played a dominant role in the functioning of the operating room. Parti...Continue Reading

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Citations

Sep 16, 2015·Anaesthesia·A Palanisamy, B Jenkins
Aug 1, 2015·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Aarjan Peter Snoek
Mar 20, 2015·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Anne Wong
May 5, 2017·Critical Care Medicine·Zeev FriedmanM Dylan Bould
Jan 1, 2016·Western Journal of Nursing Research·Desiree HenselNeil Craney
Jul 25, 2017·BMJ Quality & Safety·Brian M Wong, Shiphra Ginsburg
Jul 23, 2019·Journal of Interprofessional Care·Nadia M BajwaMathieu R Nendaz
Jun 21, 2017·Nursing & Health Sciences·Brett WilliamsIan Patrick
May 29, 2019·Journal of Perioperative Practice·Bernard Pennington, Joanne Garside
Jun 4, 2019·BMJ Quality & Safety·Daniel KatzSamuel DeMaria
May 3, 2019·Anesthesiology·Adam P SawatskyThomas J Beckman
Oct 1, 2019·Academic Medicine : Journal of the Association of American Medical Colleges·Katherina BaranovaMark Goldszmidt
Mar 10, 2020·Journal for Healthcare Quality : Official Publication of the National Association for Healthcare Quality·Sara KimNaike Bochatay
Sep 25, 2020·BMC Medical Education·Ruth BarrattGwendolyn L Gilbert
Apr 25, 2018·Culture, Medicine and Psychiatry·Sienna R CraigKristy Blackwood
May 30, 2019·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Cole EtheringtonSylvain Boet
Jul 28, 2019·Perspectives on Medical Education·Serkan ToyPriyanka Dwivedi
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Dec 29, 2019·World Neurosurgery·Benjamin R Hartley, Eric Elowitz
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Sep 8, 2021·Medical Education·Meredith Vanstone, Lawrence Grierson
Oct 5, 2021·Journal of Interprofessional Care·Javeed SukheraMark Goldszmidt

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