A multi-method exploratory study of health professional students’ experiences with compliance behaviours

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.

Conformity, obedience, and the Better than Average Effect in health professional students

“…Previous research indicates anywhere between 50% -95% of students will demonstrate conformity or obedience in a situation that can result in patient harm. 1,3,[27][28][29][33][34][35][36][37] However, based on the results of our study, overall, students believe themselves to be less susceptible to conformity and obedience than peers. Informing students, instructors, and practitioners about the BTAE can potentially increase awareness of personal susceptibility to compliance behaviour and that their own behaviour, knowledge, and skills will likely not be as good as expected.…”

“…The vignettes reflect previous studies that demonstrated conformity and obedience in health professions students and practitioners. [26][27][28][29][30] The vignettes were tested and modified using cognitive interviews, 31 a process of questioning for understanding responses process and content to identify sources of confusion in assessment, conducted with practitioners and students from health professions [3], psychology [2], educational psychology [1], and business [1] (for the vignettes with response scales, please see the supplemental material).…”

“…3 While conformity and obedience to authority are not always detrimental and can be necessary for learning, there can be deleterious outcomes. 3 Negative compliance occurs when either conformity or obedience to authority, both prevalent among trainees in the health professions, produces potentially negative outcomes for education and patient safety. [1][2][3] Converse to negative compliance is positive deviance, a behaviour, such as speaking up, that goes against norms or social and personal pressures that undermine professional values and patient safety.…”

“…3 Negative compliance occurs when either conformity or obedience to authority, both prevalent among trainees in the health professions, produces potentially negative outcomes for education and patient safety. [1][2][3] Converse to negative compliance is positive deviance, a behaviour, such as speaking up, that goes against norms or social and personal pressures that undermine professional values and patient safety. 3 Interventions to promote positive deviance through speaking up are an area of increasing focus for health professional education.…”

“…[1][2][3] Converse to negative compliance is positive deviance, a behaviour, such as speaking up, that goes against norms or social and personal pressures that undermine professional values and patient safety. 3 Interventions to promote positive deviance through speaking up are an area of increasing focus for health professional education. 4,5 Variable efficacy exists for education for responding to negative compliance scenarios and the benefits of assertiveness training and instruction on methods like the two-challenge rule a method for assertively voicing concern, are inconsistent.…”