Background Pattern-recognition is fundamental to decision-making in medicine and is developed through clinical experience. It is then natural for juniors to accept and trust the judgment of senior doctors. However, no one is infallible and errors are inevitable. The authority-gradient that exists in any clinician-student relationship discourages medical students and junior doctors from disagreeing with their superiors. It is therefore, crucial to empower junior doctors and medical students to challenge seniors to avoid serious harm to patients or team members.
Description of innovation In this student-led multi-centre project, final-year medical students will participate in two simulations, where they will manage and present an ill patient to a consultant. Unbeknownst to them, the consultant will make a deliberate misdiagnosis. We will be assessing whether or not senior medical students will challenge a serious senior error. We will then conduct a debrief, conflict resolution training and focus groups to explore the students’ perspectives on the difficulties of challenging hierarchy. The simulations will be video-recorded and rated by multiple investigators using a validated scoring tool. After students have undergone the teaching sessions, they will participate in a second simulation to assess the quality of the challenge.
Outcome This study is currently underway, with data collection due to be completed by August 2016. We hope the findings of this study will elucidate the challenges a medical student or doctors faces in challenging authority from their perspective. This will better enable us to develop a curriculum to empower students and doctors to challenge hierarchy in clinical medicine.
Take home messages The authority gradient that exists in any clinician-student relationship discourages any challenging or questioning of the senior doctor in the face of an error. Simulation and conflict resolution training could be an effective tool to empower medical students to challenge hierarchy to ensure patient safety.
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