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

Bould, M. Dylan; Sutherland, Stephanie; Sydor, Devin; Naik, Viren N.; Friedman, Zeev

doi:10.1007/s12630-015-0364-5

Cited by 121 publications

(107 citation statements)

References 15 publications

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“…I think it is a great balance with the clinical work, so I got involved in many projects, made many connections within Canada, and made it a major focus of my career. We have published a few studies along this general line of research [1,2]. There have been quantitative studies using a simulated clinical environment where the behavior of the trainees was recorded and analyzed by a group of experts using validated tools to look at behavioral differences.…”

Section: Dr Bould Thank You So Much For Taking the Time For This Inmentioning

confidence: 99%

“…In the first study, it was an ethical dilemma where, during an operation, the resident was asked by an authority to give blood to a Jehovah's Witness who had strictly refused any blood products. Despite having multiple opportunities to challenge the authority, the majority of anesthesia residents went on to give blood in the simulated environment [1,2]. We followed up from this with some qualitative work where we wanted to understand the simulated effect and whether trainees would actually act like this in real life.…”

Section: Dr Bould Thank You So Much For Taking the Time For This Inmentioning

confidence: 99%

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Medical Education Research and the Hierarchy in Medical Training: An Interview with Dr. Dylan Bould

Benzaquen

2017

UOJM

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Dr. Dylan Bould is an anesthesiologist at CHEO (Children’s Hospital of Eastern Ontario) and Director of Education Research at the University of Ottawa’s Department of Anesthesiology. Dr. Bould began training in anesthesia in the U.K. and completed fellowships in pediatric anesthesia and medical education at SickKids and St. Michael’s Hospital in Toronto, as well as a pediatric cardiac anesthesia fellowship in London, England. Over the course of his fellowships in Toronto, Dr. Bould completed a Master of Education at the University of Toronto focusing on medical education. Dr. Bould is also involved in global health, having worked in Nepal and Kenya, and was part of the organization process of the University of Zambia Anesthesia Residency Program. Dr. Bould’s current research focuses on hierarchy in medical training, mentorship in medical education, and simulation in healthcare education. RésuméDr Dylan Bould est un anesthésiologiste au Centre hospitalier pour enfants de l’est de l’Ontario (CHEO) et le directeur de la recherche en enseignement au département d’anesthésie de l’Université d’Ottawa. Dr Bould a commencé sa formation en anesthésie au Royaume-Uni et a complété des formations complémentaires (fellowships) en anesthésie pédiatrique et en enseignement médical à SickKids et à l’Hôpital St Michael à Toronto, ainsi qu’une formation en anesthésie cardiaque pédiatrique à Londres, en Angleterre. Au cours de ses formations complémentaires à Toronto, Dr Bould a complété une maîtrise en éducation à l’Université de Toronto axée sur l’enseignement médical. Dr Bould est également impliqué dans le domaine de la santé mondiale, ayant travaillé au Népal et au Kenya, et ayant aidé à mettre sur pied le programme de résidence en anesthésie à l’Université de la Zambie. La recherche actuelle de Dr Bould se concentre sur la hiérarchie présente lors de la formation médicale, le mentorat en enseignement médical, et la simulation dans l’enseignement des soins de santé.

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Section: Dr Bould Thank You So Much For Taking the Time For This Inmentioning

confidence: 99%

Section: Dr Bould Thank You So Much For Taking the Time For This Inmentioning

confidence: 99%

Medical Education Research and the Hierarchy in Medical Training: An Interview with Dr. Dylan Bould

Benzaquen

2017

UOJM

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“…As a final-year resident, I read with interest the article 1 regarding residents' reluctance to challenge authority. 3 a thought experiment in ethics, illustrates similar such challenges with scenarios of moral choice.…”

Section: To the Editormentioning

confidence: 99%

A view from the middle of the totem pole

Snoek

2015

Can J Anesth/J Can Anesth

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“…In this issue of the Journal, Bould et al 1 report on the findings of an intriguing mixed methods study that investigates the phenomenon of hierarchy in the operating room setting and its effect on decision-making. In this study, a simulated intraoperative crisis scenario was created in which resident participants were ordered by a faculty anesthesiologist (whom they had not previously met) to transfuse a Jehovah's Witness patient contrary to the patient's explicit written order.…”

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confidence: 99%

“…[3][4][5]8 Kennedy and Lingard 8 distinguish between grounded theory research, which uses all the aforementioned elements, and studies that use the grounded theory approach to analysis. Bould et al's study 1 would fall into the latter category, as the qualitative phase is part of a mixed methods study, and sampling was neither iterative nor purposeful.…”

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confidence: 99%

Using qualitative and mixed methodologies to explore hierarchy in the operating room

Wong

2015

Can J Anesth/J Can Anesth

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In this issue of the Journal, Bould et al. 1 report on the findings of an intriguing mixed methods study that investigates the phenomenon of hierarchy in the operating room setting and its effect on decision-making. In this study, a simulated intraoperative crisis scenario was created in which resident participants were ordered by a faculty anesthesiologist (whom they had not previously met) to transfuse a Jehovah's Witness patient contrary to the patient's explicit written order. This scenario took place in either a ''high'' or a ''low hierarchy'' operating room environment where scripted interactions between team members were either formal and impersonal or informal and friendly. The simulations were video recorded, and the behaviours of the residents in challenging the order to transfuse were rated using the modified Advocacy Inquiry Scale (mAIS). 2 The results of this quantitative component of their study had been previously reported. 2 This present paper focuses on the findings from the qualitative part of their study where the residents were subsequently debriefed and interviewed post-simulation. As qualitative and mixed methods studies are relatively less common in anesthesia research, it is useful to review these approaches prior to commenting further on the findings of this study.Healthcare research has been dominated traditionally by quantitative research; recently, however, qualitative research has become increasingly used. [3][4][5] Of the various qualitative methodologies, the grounded theory methodology has gained the most popularity in healthcare research, due in part to its focus on generating theory from the empirical data and its specified methodological procedures. [3][4][5] While both quantitative and qualitative research aim to represent phenomena accurately, they approach this task from different epistemological frameworks, purposes, and methodological procedures. 6,7

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

Cited by 121 publications

References 15 publications

Medical Education Research and the Hierarchy in Medical Training: An Interview with Dr. Dylan Bould

Medical Education Research and the Hierarchy in Medical Training: An Interview with Dr. Dylan Bould

A view from the middle of the totem pole

Using qualitative and mixed methodologies to explore hierarchy in the operating room

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