A cross-cultural survey of residents' perceived barriers in questioning/challenging authority

Abstract

Objectives: To identify perceived barriers to residents' questioning or challenging their seniors, to determine how these barriers affect decisions, and to assess how these barriers differ across cultures. Method: A written questionnaire was administered to residents in teaching hospitals in the US and Japan to assess factors affecting residents' willingness to question or challenge their superiors. The responses were analyzed for statistical significance of differences between the two cultures and to determine the importance of issues affecting decisions. Results: Questionnaires were completed by 175 US and 65 Japanese residents, with an overall response rate of 71%. Trainees from both countries believe that questioning and challenging contribute to safety. The perceived importance of specific beliefs about the workplace differed across cultures in seven out of 22 questions. Residents' decisions to make a challenge were related to the relationships and perceived response of the superiors. There was no statistical difference between the US and Japanese residents in terms of the threshold for challenging their seniors. Conclusion:We have identified attributes of residents' beliefs of communication, including several crosscultural differences in the importance of values and issues affecting one's decision to question or challenge. In contrast, there was no difference in the threshold for challenging seniors by the Japanese and US residents studied. Changes in organizational and professional culture may be as important, if not more so, than national culture to encourage ''speaking up''. Residents should be encouraged to overcome barriers to challenging, and training programs should foster improved relationships and communication between trainers and trainees.

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

“…Kobayashi et al used a quantitative questionnaire to investigate the willingness to challenge authority in United States and Japanese residents. 7 They found some differences in personal beliefs regarding communication and safety between Japanese and United States trainees but no difference in their self-reported willingness to challenge authority. Nevertheless, we are aware that the prediction of future actions by the self is often inaccurate, 17,18 and it is not clear whether the reported willingness to challenge authority accurately represents residents' behaviour.…”

“…A team's dynamic may be relatively egalitarian or more hierarchical depending on many factors, including individual leadership and followership styles and cultural differences at many levels -from national characteristics 5,6 to the culture of a specific institution. 7 Previous research has shown that subordinates within a hierarchy are often unwilling to challenge their superiors, even when it's clear that failure to do so risks unethical practice or serious patient harm. 8,9 A prominent example is the high profile case of Elaine Bromiley, a young previously healthy woman who died from hypoxic brain damage during elective surgery when deprived of attempts at a surgical airway.…”

Cross-cultural Comparison of Pharmacy Students’ Attitudes, Knowledge, Practice, and Barriers Regarding Evidence-based Medicine

“…17,18 Especially in medicine, decisionmaking historically was hierarchy-based or authority or "expert"-based medicine. 41,42 In such an environment, students may not be comfortable in using EBM without a role model. In contrast, students in the US, in an individualistic society rely less on role models for new fields, and may be more comfortable to take the initiative.…”

Radiation Oncology Quality and Safety Considerations in Low-Resource Settings: A Medical Physics Perspective

“…The emphasis should be on "no question is a dumb question" so that all staff will readily ask questions of their peers, superiors and subordinates without feeling intimidated. One study performed a cross-cultural survey of medical residents to determine perceived barriers in questioning and challenging authority 51 . The conclusion was that organizational and professional culture may be as important, if not more so, than national culture to encourage "speaking up".…”