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Beran TN, Altabbaa G, Oddone Paolucci E. Observational Study of Conformity in Yet Another Medical Learning Environment: Conformity to Preceptors During High-Fidelity Simulation. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2023; 14:1445-1452. [PMID: 38149121 PMCID: PMC10750487 DOI: 10.2147/amep.s427996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/27/2023] [Indexed: 12/28/2023]
Abstract
Purpose Altering one's behavior to comply with inaccurate suggestions made by others (i.e., conformity) has been studied since the 1950s. Although several studies have documented its occurrence in medical education, it has yet to be examined in a high-fidelity simulation environment. It was hypothesized that a large majority of learners would conform to a preceptor. Patients and Methods A total of 42 student dyads (a medical student paired with a resident) participated in one of four clinical scenarios to manage the diagnosis and treatment of a simulated patient encounter. Once the learners became familiar with the patient's case, a preceptor entered the simulation, offered an equivocal suggestion about diagnosis or management, and then left. Two raters observed the video recordings of how the learners managed the case after this suggestion was made. The nature of these interactions was also documented. Results Sixteen (38.10%) of the 42 medical student dyads conformed to the equivocal information presented by the preceptors. Observations of these interactions showed that all of the medical students conformed to the residents, but not all of the medical students conformed to the preceptors. Conclusion Many learners conform to preceptors by acting on their equivocal suggestion when managing a patient case during high-fidelity simulation.
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Affiliation(s)
- Tanya N Beran
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Ghazwan Altabbaa
- Department of Medicine, University of Calgary and Rockyview General Hospital, Calgary, Alberta, Canada
| | - Elizabeth Oddone Paolucci
- Department of Community Health Sciences and Department of Surgery, University of Calgary, Calgary, Alberta, Canada
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Violato E, Witschen B, Violato E, King S. A behavioural study of obedience in health professional students. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:293-321. [PMID: 34807358 PMCID: PMC9117351 DOI: 10.1007/s10459-021-10085-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 11/14/2021] [Indexed: 06/13/2023]
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.
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Affiliation(s)
- Efrem Violato
- Department of Educational Psychology, Faculty of Education, University of Alberta, Education North, 11210 - 87 Ave, Edmonton, AB, T6G 2G5, Canada.
| | - Brian Witschen
- School of Health and Life Sciences, Northern Alberta Institute of Technology, Edmonton, Canada
| | - Emilio Violato
- Department of Psychology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Sharla King
- Department of Educational Psychology, Faculty of Education, University of Alberta, Education North, 11210 - 87 Ave, Edmonton, AB, T6G 2G5, Canada
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Guraya SS, Yusoff MSB, Rashid-Doubell F, Harkin DW, Al-Amad SH, Fredericks S, Halabi MOO, Abdullah N, Moussa H, Mallah SIY, Sefen JAN, AlKoheji HKARMI, Althawadi MEA, Alabbasi LA, Nor MZM, Reguig F, Guraya SY. Changing Professional Behaviors in the Digital World Using the Medical Education e-Professionalism (MEeP) Framework-A Mixed Methods Multicentre Study. Front Med (Lausanne) 2022; 9:846971. [PMID: 35425778 PMCID: PMC9004460 DOI: 10.3389/fmed.2022.846971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 03/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background: There is increasing evidence on the exponential use of technology-based social media in medical field that has led to a proliferation of unprofessional behaviors in digital realm. Educating, training, and changing the behaviors of healthcare professionals are essential elements to restrain the rising unprofessional incidents. Therefore, this research was designed to determine the impact of an interventional workshop on the medical and dental students in improving their professional behaviors in the digital world using the newly developed medical Education e-Professionalism (MEeP) framework. Methods We adopted the Theory of Planned Behavior (TPB) as a benchmark reference which explores constructs intertwined with the mission-based MEeP framework; values (whistleblowing-raising concerns), behaviors (being responsible in the digital world) and identity (reflective practice in the digital world). A multicentre 3-phased mixed-method study was conducted using a pre-workshop survey, an online interventional workshop, and a post-workshop survey. SPSS and NVivo were the tools used for the data analysis. Results A total of 130 students registered for workshop out of which 120 completed the pre-workshop survey, 62 joined the workshop and 59 completed the workshop and post-workshop survey. From the whistleblowing – raising concern perspective, we found that attitudes and perceived behavioral control had a significant relationship. While for responsible in digital world category, attitude and perceived behavioral control had a significant bearing on the intentions. Third, for reflective practice, attitude and subjective norms significantly enhanced the intention of participants. A multi layered thematic analysis yielded four overarching themes of attitudes, subjective norms, perceived behavioral control and intentions. Most students showed positive attitudes of being reflective, self-directed, and humane. Students realized the subjective norms had made them conscientious, self-aware and conformative. While perceived behavioural control manifested as identity and Intentions were heavily reliant on self-actualization. Conclusion Our mixed method study found that the interventional workshop using MEeP framework significantly improved attitudes, subjective norms, perceived behavioral control, and intentions. This study provides valuable evidence of MEeP framework evaluation using the theoretical underpinning of TPB by reporting positive changes in professional values, behaviors, and identities of undergraduate medical and dental students.
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Affiliation(s)
- Shaista Salman Guraya
- Royal College of Surgeons Ireland, Medical University of Bahrain, Busaiteen, Bahrain.,Department of Medical Education, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | | | - Fiza Rashid-Doubell
- Royal College of Surgeons Ireland, Medical University of Bahrain, Busaiteen, Bahrain
| | - Denis W Harkin
- Faculty of Medicine and Health Sciences, Royal College of Surgeons Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Suhail H Al-Amad
- College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Salim Fredericks
- Royal College of Surgeons Ireland, Medical University of Bahrain, Busaiteen, Bahrain
| | | | - Natasya Abdullah
- Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Nilai, Malaysia
| | - Hatem Moussa
- Department of Surgery, American Hospital Dubai, Dubai, United Arab Emirates
| | | | | | | | | | | | - Mohd Zarawi Mat Nor
- Department of Medical Education, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Farida Reguig
- Department of Surgery, American Hospital Dubai, Dubai, United Arab Emirates
| | - Salman Yousuf Guraya
- Clinical Sciences Department, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
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Violato E, King S, Bulut O. Conformity, obedience, and the Better than Average Effect in health professional students. CANADIAN MEDICAL EDUCATION JOURNAL 2022; 13:55-64. [PMID: 35291458 PMCID: PMC8909824 DOI: 10.36834/cmej.71970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Compliance, through conformity and obedience to authority, can produce negative outcomes for patient safety, as well as education. To date, educational interventions for dealing with situations of compliance or positive deviance have shown variable results. Part of the challenge for education on compliance may result from disparities between learners' expectations about their potential for engaging in positive deviance and the actual likelihood of engaging in positive deviance. More specifically, students may demonstrate a Better Than Average Effect (BTAE), the tendency for people to believe they are comparatively better than the average across a wide range of behaviours and skills. METHODS Four vignettes were designed and piloted using cognitive interviews, to investigate the BTAE. Conformity and obedience to authority were each addressed with two vignettes. The vignettes were included in a survey distributed to Canadian health professional students across multiple programs at several different institutions during the Winter 2019 semester. Self-evaluation of behaviour was investigated using a one-sample proportion test. Demographic data were investigated using logistic regression to identify predictors of the BTAE. RESULTS Participants demonstrated the BTAE for expected behaviour compared to peers for situations of conformity and obedience to authority. Age, sex, and program year were identified as potential predictors for exhibiting the BTAE. CONCLUSIONS This study demonstrated that health professional students expect that they will behave better than average in compliance scenarios. Health professional students are not exempt from this cognitive bias in self-assessment. The results have implications for education on compliance, positive deviance, and patient safety.
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Affiliation(s)
- Efrem Violato
- Department of Educational Psychology, University of Alberta, Alberta, Canada
| | - Sharla King
- Department of Educational Psychology, University of Alberta, Alberta, Canada
| | - Okan Bulut
- Department of Educational Psychology, University of Alberta, Alberta, Canada
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Bretagne V, Delapierre A, Cerasuolo D, Bellot A, Marcelli C, Guillois B. Randomized Controlled Study of a Training Program for Knee and Shoulder Arthrocentesis on Procedural Simulators with Assessment on Cadavers. ACR Open Rheumatol 2022; 4:312-321. [PMID: 34989181 PMCID: PMC8992473 DOI: 10.1002/acr2.11400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 11/22/2021] [Accepted: 11/30/2021] [Indexed: 12/01/2022] Open
Abstract
Objective The study objective was to assess the efficacy of simulators in improving the competence of students in performing a knee and shoulder arthrocentesis on cadavers and to determine the minimum number of simulator training procedures needed to achieve competence in arthrocentesis. Methods Two groups of 15 medical students were each trained to perform a single joint arthrocentesis (“knee group” and “shoulder group”) on a simulator to serve as a control for the other. The two groups received the same theoretical training (anatomy, arthrocentesis techniques, ultrasound, and hybrid simulation). Each student punctured the two joints on a cadaver. A student was considered “competent on the cadaver” if they succeeded at two or more arthrocentesis procedures out of the three tests on the joint on which they were trained. The minimum threshold value to be competent was calculated by a receiver operating characteristic curve and the Youden index. An assessment of theoretical knowledge and confidence level in joint arthrocentesis was carried out at the start and end of the study. Results Twenty‐two out of 29 students (75.8%) achieved competence in arthrocentesis at the joint for which they were trained. Of the students in the knee group, 79% were competent on the cadaver’s knee versus 60% of the students in the shoulder group (P = 0.43). Of students in the shoulder group, 74% were competent on the cadaver’s shoulder versus 57% of students in the knee group (P = 0.45). Four training punctures on a simulator are necessary to achieve competence on a cadaver. The students’ confidence level in arthrocentesis increased significantly during the study, as did the students’ theoretical knowledge. Conclusion Knee and shoulder arthrocentesis success rates were not statistically different between the two training groups. A minimum number of 4.0 training arthrocentesis on a simulator is needed to achieve competency on a cadaver.
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Altabbaa G, Beran TN, Drefs MA, Oddone Paolucci E. Twelve tips for using simulation to teach about conformity behaviors in medical education. MEDICAL TEACHER 2021; 43:1360-1367. [PMID: 33621151 DOI: 10.1080/0142159x.2021.1879375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Decision-making at different moments in patient care is fraught with potential latent threats. Social influence is one such threat that is increasingly being reported in healthcare and medical education. While different teaching modalities might bring attention to the various ways in which learners conform during clinical decision-making, simulation stands alone as a robust experiential approach to trigger and influence behaviors of learners. Our article provides 12 tips for teaching about conformity using simulation as a modality. This article contributes to medical education because of its focus on a variety of nuances and adaptations required in the simulation scenario design and reflective feedback when teaching about the impact of social influence on clinical decision making. While such a learning outcome presents an unusual challenge for teachers and learners, the ultimate outcome remains the same - that is - to provide meaningful learning while holding honesty and safety of our learners as core values.
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Affiliation(s)
- Ghazwan Altabbaa
- Clinical Associate Professor, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Tanya N Beran
- Professor, Medical Education, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Michelle Arlene Drefs
- Associate Professor, Werklund School of Education, University of Calgary, Calgary, Canada
| | - Elizabeth Oddone Paolucci
- Associate Professor, Medical Education, Department of Community Health Sciences, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Violato E, King S, Bulut O. A multi-method exploratory study of health professional students' experiences with compliance behaviours. BMC MEDICAL EDUCATION 2020; 20:359. [PMID: 33046072 PMCID: PMC7552343 DOI: 10.1186/s12909-020-02265-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/28/2020] [Indexed: 05/12/2023]
Abstract
BACKGROUND Research in healthcare, including students as participants, has begun to document experiences with negative compliance, specifically conformity and obedience. There is a growing body of experimental and survey literature, however, currently lacking is a direct measure of the frequency at which health professional students have negative experiences with conformity and obedience integrated with psychological factors, the outcomes of negative compliance, and students' perceptions. METHODS To develop empirical knowledge about the frequency of negative compliance and student perceptions during health professional education a multi-methods survey approach was used. The survey was administered to health professional students across ten disciplines at four institutions. RESULTS The results indicated students regularly experience obedience and conformity and are influenced by impression management and displacement of responsibility. Moral distress was identified as a consistent negative outcome. Student self-reported experiences aligned with the empirical findings. CONCLUSIONS The findings of the present study demonstrate the pervasiveness of experiences with negative compliance during health professional's education along with some attendant psychological factors. The findings have educational and practical implications, as well as pointing to the need for further integration of social and cognitive psychology in explaining compliance in healthcare. The results are likely generalizable to a population level however replication is encouraged to better understand the true frequency of negative compliance at a health professional population level.
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Affiliation(s)
- Efrem Violato
- Department of Educational Psychology, Faculty of Education, University of Alberta, 6-132 Education North, 11210 - 87 Ave, Edmonton, AB, T6G 2G5, Canada.
| | - Sharla King
- Department of Educational Psychology, Faculty of Education, University of Alberta, 6-132 Education North, 11210 - 87 Ave, Edmonton, AB, T6G 2G5, Canada
| | - Okan Bulut
- Department of Educational Psychology, Faculty of Education, University of Alberta, 6-132 Education North, 11210 - 87 Ave, Edmonton, AB, T6G 2G5, Canada
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Taylor-Phillips S, Stinton C. Double reading in breast cancer screening: considerations for policy-making. Br J Radiol 2020; 93:20190610. [PMID: 31617741 PMCID: PMC7055445 DOI: 10.1259/bjr.20190610] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/09/2019] [Accepted: 10/13/2019] [Indexed: 01/04/2023] Open
Abstract
In this article, we explore the evidence around the relative benefits and harms of breast cancer screening using a single radiologist to examine each female's mammograms for signs of cancer (single reading), or two radiologists (double reading). First, we briefly explore the historical evidence using film-screen mammography, before providing an in-depth description of evidence using digital mammography. We classify studies according to which exact version of double reading they use, because the evidence suggests that effectiveness of double reading is contingent on whether the two radiologists are blinded to one another's decisions, and how the decisions of the two radiologists are integrated. Finally, we explore the implications for future mammography, including using artificial intelligence as the second reader, and applications to more complex three-dimensional imaging techniques such as tomosynthesis.
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Affiliation(s)
| | - Chris Stinton
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, England
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Cherng CG, Yu L. Sex differences and the modulating effects of gonad intactness on behavioral conformity in a mouse model. CHINESE J PHYSIOL 2019; 62:245-255. [PMID: 31793460 DOI: 10.4103/cjp.cjp_42_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Although gender differences in conformity are noticed in human studies, cultural norms and psychosocial factors inevitably affect such differences. Biological factors, especially the gonadal hormones and the brain regions involved, contributing to the sex differences in behavioral conformity remained scarcely explored. To prevent psychosocial and cultural norm confounds, intact and gonadectomized male and female mice were used to assess the modulating effects of gonadal hormones on behavioral conformity and such conformity-related brain regions using an approach of choice paradigm. Intact and gonadectomized mice' choices for the nonrewarded runway were assessed when these experimental mice were alone versus with a group, consisting of three same-sex noncagemates choosing the respective experimental mice' nonrewarded runway, in a double-J-shaped maze test. Although male and female mice exhibited comparable rewarded runway choices at the conclusion of the operant training procedures and in the test individually, male mice demonstrated greater conformity index as compared to female mice when group tested. Gonadectomy, done at their 4 or 9 weeks of age, decreased males' conformity index but did not affect females' when both sexes were group tested. Such gonadectomy did not affect the conditioning or conformity index when tested individually in either sex. Female mice had higher serum corticosterone (CORT) levels when group tested as compared to the female mice tested individually and male mice. Finally, the number of FOS-staining cells in high conformity-displaying mice was found less than it in the low conformity-performing mice in the nucleus accumbens. Taken together, we conclude that testis-derived hormones, at least, play a role in enhancing behavioral conformity in male mice. CORT and nucleus accumbal neuronal activity deserve further investigation for their involvement in behavioral conformity.
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Affiliation(s)
- Chianfang G Cherng
- Education Center of Humanities and Social Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Lung Yu
- Department of Physiology; Institute of Behavioral Medicine, National Cheng Kung University College of Medicine, Tainan, Taiwan
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Kaba A, Beran TN. Navigating complexity of advocacy: the role of peer pressure. MEDICAL EDUCATION 2019; 53:317-318. [PMID: 30537252 DOI: 10.1111/medu.13754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Alyshah Kaba
- eSim Provincial Program, Quality Health Improvement, Alberta Health Services, Department of Community Health Sciences, Cumming School of Medicine, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Tanya N Beran
- Medical Education and Research, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Grendar J, Beran T, Oddone-Paolucci E. Experiences of pressure to conform in postgraduate medical education. BMC MEDICAL EDUCATION 2018; 18:4. [PMID: 29298717 PMCID: PMC5751422 DOI: 10.1186/s12909-017-1108-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 12/14/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Perception of pressure to conform prevents learners from actively participating in educational encounters. We expected that residents would report experiencing different amounts of pressure to conform in a variety of educational settings. METHODS A total of 166 residents completed questionnaires about the frequency of conformity pressure they experience across 14 teaching and clinical settings. We examined many individual characteristics such as their age, sex, international student status, level of education, and tolerance of ambiguity; and situational characteristics such as residency program, type of learning session, status of group members, and type of rotation to determine when conformity pressure is most likely to occur. RESULTS The majority of participants (89.8%) reported pressure to conform at least sometimes in at least one educational or clinical setting. Residents reported higher rates of conformity during informal, rather than formal, teaching sessions, p < .001. Also, pressure was greater when residents interacted with higher status group members, but not with the same or lower level status members, p < .001. Effect sizes were in the moderate range. CONCLUSIONS The findings suggest that most residents do report feeling pressure to conform in their residency settings. This result is consistent with observations of medical students, nursing students, and clerks conforming in response to inaccurate information within experimental studies. Perception of pressure is associated with the setting rather than the trainee personal characteristics.
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Affiliation(s)
- Jan Grendar
- Department of Postgraduate Medical Education, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Tanya Beran
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive, NW, Calgary, AB T2N 4Z6 Canada
| | - Elizabeth Oddone-Paolucci
- Departments of Community Health Sciences and Surgery, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Brydges R, Stroud L, Wong BM, Holmboe ES, Imrie K, Hatala R. Core Competencies or a Competent Core? A Scoping Review and Realist Synthesis of Invasive Bedside Procedural Skills Training in Internal Medicine. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:1632-1643. [PMID: 28489618 DOI: 10.1097/acm.0000000000001726] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE Invasive bedside procedures are core competencies for internal medicine, yet no formal training guidelines exist. The authors conducted a scoping review and realist synthesis to characterize current training for lumbar puncture, arthrocentesis, paracentesis, thoracentesis, and central venous catheterization. They aimed to collate how educators justify using specific interventions, establish which interventions have the best evidence, and offer directions for future research and training. METHOD The authors systematically searched Medline, Embase, the Cochrane Library, and ERIC through April 2015. Studies were screened in three phases; all reviews were performed independently and in duplicate. The authors extracted information on learner and patient demographics, study design and methodological quality, and details of training interventions and measured outcomes. A three-step realist synthesis was performed to synthesize findings on each study's context, mechanism, and outcome, and to identify a foundational training model. RESULTS From an initial 6,671 studies, 149 studies were further reduced to 67 (45%) reporting sufficient information for realist synthesis. Analysis yielded four types of procedural skills training interventions. There was relative consistency across contexts and significant differences in mechanisms and outcomes across the four intervention types. The medical procedural service was identified as an adaptable foundational training model. CONCLUSIONS The observed heterogeneity in procedural skills training implies that programs are not consistently developing residents who are competent in core procedures. The findings suggest that researchers in education and quality improvement will need to collaborate to design training that develops a "competent core" of proceduralists using simulation and clinical rotations.
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Affiliation(s)
- Ryan Brydges
- R. Brydges is assistant professor, Department of Medicine, University of Toronto, and scientist, Wilson Centre, University Health Network, Toronto, Ontario, Canada. L. Stroud is assistant professor, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. B.M. Wong is associate professor, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. E.S. Holmboe is senior vice president for milestones development and evaluation, Accreditation Council for Graduate Medical Education, Chicago, Illinois. K. Imrie is immediate past president, Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada. R. Hatala is associate professor, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Bhavsar TB, Sibbitt WL, Band PA, Cabacungan RJ, Moore TS, Salayandia LC, Fields RA, Kettwich SK, Roldan LP, Suzanne Emil N, Fangtham M, Bankhurst AD. Improvement in diagnostic and therapeutic arthrocentesis via constant compression. Clin Rheumatol 2017; 37:2251-2259. [PMID: 28913649 DOI: 10.1007/s10067-017-3836-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 09/04/2017] [Accepted: 09/07/2017] [Indexed: 11/29/2022]
Abstract
We hypothesized that constant compression of the knee would mobilize residual synovial fluid and promote successful arthrocentesis. Two hundred and ten knees with grade II-III osteoarthritis were included in this paired design study: (1) conventional arthrocentesis was performed with manual compression and success and volume (milliliters) determined; and (2) the intra-articular needle was left in place, and a circumferential elastomeric brace was tightened on the knee to provide constant compression. Arthrocentesis was attempted again and additional fluid volume was determined. Diagnostic procedural cost-effectiveness was determined using 2017 US Medicare costs. No serious adverse events were noted in 210 subjects. In the 158 noneffusive (dry) knees, sufficient synovial fluid for diagnostic purposes (≥ 2 ml) was obtained in 5.0% (8/158) without compression and 22.8% (36/158) with compression (p = 0.0001, z for 95% CI = 1.96), and the absolute volume of arthrocentesis fluid obtained without compression was 0.28 ± 0.79 versus 1.10 ± 1.81 ml with compression (293% increase, p = 0.0001). In the 52 effusive knees, diagnostic synovial fluid (≥ 2 ml) was obtained in 75% (39/52) without compression and 100% (52/52) with compression (p = 0.0001, z for 95% CI = 1.96), and the absolute volume of arthrocentesis without compression was 14.7 ± 13.8 versus 25.3 ± 15.5 ml with compression (72.1% increase, p = 0.0002). Diagnostic procedural cost-effectiveness was $655/sample without compression and $387/sample with compression. The new technique of constant compression via circumferential mechanical compression mobilizes residual synovial fluid beyond manual compression improving the success, cost-effectiveness, and yield of diagnostic and therapeutic arthrocentesis in both the effusive and noneffusive knee.
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Affiliation(s)
- Tej B Bhavsar
- The Center for Rheumatology LLC, 6 Care Lane, Saratoga Springs, NY, 12866, USA
| | - Wilmer L Sibbitt
- Department of Internal Medicine, Division of Rheumatology and School of Medicine, University of New Mexico Health Sciences Center, MSC 10 5550, 5th FL ACC, Albuquerque, NM, 87131, USA.
| | - Philip A Band
- Department of Orthopaedic Surgery, Biochemistry & Molecular Pharmacology, NYU School of Medicine, 301 East 17th Street, New York City, NY, 10003, USA
| | - Romy J Cabacungan
- Arizona Arthritis and Rheumatology Associates, P.C., 2001 W. Orange Grove Road, Suite 104, Tucson, AZ, 85704, USA
| | - Timothy S Moore
- Department of Internal Medicine, Division of Rheumatology and School of Medicine, Penncare Rheumatology Associates, University of Pennsylvania Health System, 3737 Market St Fl 8, Philadelphia, PA, 19104, USA
| | | | - Roderick A Fields
- Department of Internal Medicine, Division of Rheumatology and School of Medicine, University of New Mexico Health Sciences Center, MSC 10 5550, 5th FL ACC, Albuquerque, NM, 87131, USA
| | | | - Luis P Roldan
- School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, 87131, USA
| | - N Suzanne Emil
- Department of Internal Medicine, Division of Rheumatology and School of Medicine, University of New Mexico Health Sciences Center, MSC 10 5550, 5th FL ACC, Albuquerque, NM, 87131, USA
| | - Monthida Fangtham
- Department of Internal Medicine, Division of Rheumatology and School of Medicine, University of New Mexico Health Sciences Center, MSC 10 5550, 5th FL ACC, Albuquerque, NM, 87131, USA
| | - Arthur D Bankhurst
- Department of Internal Medicine, Division of Rheumatology and School of Medicine, University of New Mexico Health Sciences Center, MSC 10 5550, 5th FL ACC, Albuquerque, NM, 87131, USA
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Kaba A, Beran TN. Impact of peer pressure on accuracy of reporting vital signs: An interprofessional comparison between nursing and medical students. J Interprof Care 2017; 30:116-22. [PMID: 26833111 DOI: 10.3109/13561820.2015.1075967] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The hierarchical relationship between nursing and medicine has long been known, yet its direct influence on procedural tasks has yet to be considered. Drawing on the theory of conformity from social psychology, we suggest that nursing students are likely to report incorrect information in response to subtle social pressures imposed by medical students. Second-year medical and third-year nursing students took vital signs readings from a patient simulator. In a simulation exercise, three actors, posing as medical students, and one nursing student participant all took a total of three rounds of vital signs on a high-fidelity patient simulator. In the first two rounds the three actors individually stated the same correct vital signs values, and on the third round the three actors individually stated the same incorrect vital sign values. This same procedure was repeated with actors posing as nursing students, and one medical student. A two-way analysis of variance (ANOVA) revealed that nursing student participants (M = 2.84; SD = 1.24) reported a higher number of incorrect vital signs than did medical student participants (M = 2.13; SD = 1.07), F (1,100) = 5.51, p = 0.021 (Cohen's d = 0.61). The study indicated that social pressure may prevent nursing students from questioning incorrect information within interprofessional environments, potentially affecting quality of care.
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Affiliation(s)
- Alyshah Kaba
- a Medical Education and Research, Department of Community Health Sciences, Cumming School of Medicine , University of Calgary , Calgary , Alberta , Canada
| | - Tanya N Beran
- a Medical Education and Research, Department of Community Health Sciences, Cumming School of Medicine , University of Calgary , Calgary , Alberta , Canada
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15
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Research Advances in Conformity to Peer Pressure: A Negative Side Effect of Medical Education. HEALTH PROFESSIONS EDUCATION 2015. [DOI: 10.1016/j.hpe.2015.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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16
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Beran TN, Kaba A, Caird J, McLaughlin K. The good and bad of group conformity: a call for a new programme of research in medical education. MEDICAL EDUCATION 2014; 48:851-9. [PMID: 25113112 DOI: 10.1111/medu.12510] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 02/24/2014] [Accepted: 04/16/2014] [Indexed: 05/26/2023]
Abstract
CONTEXT Given that a significant portion of medical education occurs in various social settings (small groups, large classes, clinical environments), it is critical to examine how group members interact. One type of influence on these interactions is conformity, whereby an individual changes his or her own behaviour to match incorrect responses of others in a group. Conformity to peer pressure has been replicated in experimental research conducted in many countries over the last 60 years. There is newly emerging empirical evidence of this effect in medical education, suggesting that subtle motivations and pressures within a group may prevent students from challenging or questioning information that seems incorrect. OBJECTIVES This narrative review aims to present an overview of theory and findings in research into conformity in the fields of social psychology, business, sociology and aviation theory to demonstrate its direct relevance to medical education and the health professions. METHODS We searched online databases (MEDLINE, PubMed, PsycINFO and ProQuest) from the University of Calgary catalogue. We also searched citations in articles reviewed and references provided by colleagues. We limited our narrative review to publications released between 1950 and 2012. RESULTS Group conformity behaviour may be one of a number of communication challenges associated with interprofessional care, and may represent a factor contributing to the burden of adverse events. This paper calls for a new programme of research into conformity in medical education that provides systematic empirical evidence of its relevance and applications in education, health care and practice. CONCLUSIONS This review reveals decades of anecdotal and empirical evidence that conformity is a pervasive phenomenon across disciplines. Further research is needed to elucidate which situations pose the greatest risk for the occurrence of conformity, how to manage it in practice and its implications for patient safety.
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Affiliation(s)
- Tanya N Beran
- Department of Community Health Sciences, Medical Education Specialization, Calgary, Alberta, Canada
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17
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Hibbert EJ, Lambert T, Carter JN, Learoyd DL, Twigg S, Clarke S. A randomized controlled pilot trial comparing the impact of access to clinical endocrinology video demonstrations with access to usual revision resources on medical student performance of clinical endocrinology skills. BMC MEDICAL EDUCATION 2013; 13:135. [PMID: 24090039 PMCID: PMC3851453 DOI: 10.1186/1472-6920-13-135] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 10/01/2013] [Indexed: 05/13/2023]
Abstract
BACKGROUND Demonstrating competence in clinical skills is key to course completion for medical students. Methods of providing clinical instruction that foster immediate learning and potentially serve as longer-term repositories for on-demand revision, such as online videos demonstrating competent performance of clinical skills, are increasingly being used. However, their impact on learning has been little studied. The aim of this study was to determine the value of adjunctive on-demand video-based training for clinical skills acquisition by medical students in endocrinology. METHODS Following an endocrinology clinical tutorial program, 2nd year medical students in the pre-assessment revision period were recruited and randomized to either a set of bespoke on-line clinical skills training videos (TV), or to revision as usual (RAU). The skills demonstrated on video were history taking in diabetes mellitus (DMH), examination for diabetes lower limb complications (LLE), and examination for signs of thyroid disease (TE). Students were assessed on these clinical skills in an observed structured clinical examination two weeks after randomization. Assessors were blinded to student randomization status. RESULTS For both diabetes related clinical skills assessment tasks, students in the TV group performed significantly better than those in the RAU group. There were no between group differences in thyroid examination performance. For the LLE, 91.7% (n = 11/12) of students randomized to the video were rated globally as competent at the skill compared with 40% (n = 4/10) of students not randomized to the video (p = 0.024). For the DMH, 83.3% (n = 10/12) of students randomized to the video were rated globally as competent at the skill compared with 20% (n = 2/10) of students not randomized to the video (p = 0.007). CONCLUSION Exposure to high quality videos demonstrating clinical skills can significantly improve medical student skill performance in an observed structured clinical examination of these skills, when used as an adjunct to clinical skills face-to-face tutorials and deliberate practice of skills in a blended learning format. Video demonstrations can provide an enduring, on-demand, portable resource for revision, which can even be used at the bedside by learners. Such resources are cost-effectively scalable for large numbers of learners.
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Affiliation(s)
- Emily J Hibbert
- Sydney Medical School Nepean, University of Sydney, PO Box 63, Penrith, NSW 2751, Australia
- Nepean Hospital, Penrith, Australia
| | - Tim Lambert
- Sydney Medical School Concord, University of Sydney, Clinical Sciences Building, Concord Hospital, Concord, NSW 2139, Australia
- Brain and Mind Research Institute, University of Sydney, 100 Mallett Street, Camperdown, NSW 2050, Australia
| | - John N Carter
- Hornsby Hospital, Palmerston Rd, Hornsby, NSW 2077, Australia
- Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia
| | - Diana L Learoyd
- Sydney Medical School Northern, University of Sydney, Sydney, Australia
- Department of Endocrinology, Royal North Shore Hospital, Pacific Highway, St Leonards, NSW 2065, Australia
| | - Stephen Twigg
- Sydney Medical School Central, University of Sydney, Sydney, Australia
- Department of Endocrinology, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW, 2050, Australia
| | - Stephen Clarke
- Sydney Medical School Northern, University of Sydney, Sydney, Australia
- Department of Endocrinology, Royal North Shore Hospital, Pacific Highway, St Leonards, NSW 2065, Australia
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