title: Power and conflict: the effect of a superior's interpersonal behaviour on trainees' ability to challenge authority during a simulated airway emergency.
abstract: 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.
authors: Mount Sinai Hospital, Toronto, Ontario, Canada.
authors: Z
authors: Z
authors: Friedman
authors: St Michael's Hospital, Toronto, Ontario, Canada.
authors: M A
authors: MA
authors: Hayter
authors: The Hospital for Sick Children, Toronto, Ontario, Canada.
authors: T C
authors: TC
authors: Everett
authors: The Hospital for Sick Children, Toronto, Ontario, Canada.
authors: C T
authors: CT
authors: Matava
authors: Mount Sinai Hospital, Toronto, Ontario, Canada.
authors: L M K
authors: LM
authors: Noble
authors: Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
authors: M D
authors: MD
authors: Bould
mesh_terms: D058109:Airway Management / Q000592:standards*; D000776:Anesthesiology / Q000193:education*; D003142:Communication; D003220:Conflict, Psychological; D003253:Consultants / Q000523:psychology; D003657:Decision Making; D004503:Education, Medical, Graduate / Q000458:organization & administration*; D004630:Emergencies; D005260:Female; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D008505:Medical Staff, Hospital / Q000523:psychology; D009864:Ontario; D016544:Patient Simulation; D011209:Power, Psychological; D011897:Random Allocation