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.
Highlights
In the twenty years after the 1999 Institute of Medicine report, To Err is Human (Kohn et al, 1999), iatrogenic sources of death continue to be a major challenge globally (Cohen & Patel, 2020)
One of the most prominent means to improve patient safety that has emerged is the focused integration of different healthcare professionals into cohesive teams through Interprofessional Education and Collaborative Practice (IPECP) (Cosby, 2017; Frenk et al, 2010; Kohn et al, 1999; World Health Organization, 2010)
There was a final total of 19 participants from the Advanced Care Paramedic (ACP) program and 40 from the Respiratory Therapy (RT) pro‐ gram with 28 Females (2 ACP, 26 RT) and 31 Males (17 ACP, 14 RT)
Summary
One of the most prominent means to improve patient safety that has emerged is the focused integration of different healthcare professionals into cohesive teams through Interprofessional Education and Collaborative Practice (IPECP) (Cosby, 2017; Frenk et al, 2010; Kohn et al, 1999; World Health Organization, 2010). IPECP has grown over the last two decades (Reeves et al, 2017), and is often presented as a panacea to numerous problems in healthcare It has been proclaimed Interprofessional Education (IPE) is a great truth awaiting validation (Gilbert, 2013) and that the benefits of Interpro‐ fessional Collaboration (IPC) are clearly documented and the need for IPE in undergradu‐ ate and graduate education is supported by the literature (Wellmon et al, 2017). A growing body of research reports issues with compliance through hierarchies and professional cul‐ tures (Alingh et al, 2019; Holmes et al, 2014; Mak-van der Vossen et al, 2018; Martinez et al, 2017; Pattni et al, 2019; Peadon et al, 2020; Schwappach et al, 2019), conformity and peer pressure (Beran et al, 2013, 2015; Kaba & Beran, 2016; Kaba, et al, 2016a, b) and authority (Bould et al, 2015; Calhoun et al, 2014; Delaloye et al, 2017; Friedman et al, 2015; Kuo et al, 2020; Shanks et al, 2020; Sydor et al, 2013)
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