Power and conflict: the effect of a superior's interpersonal behaviour on trainees' ability to challenge authority during a simulated airway emergency

Anaesthesia. 2015 Oct;70(10):1119-29. doi: 10.1111/anae.13191. Epub 2015 Aug 21.


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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Airway Management / standards*
  • Anesthesiology / education*
  • Communication
  • Conflict, Psychological
  • Consultants / psychology
  • Decision Making
  • Education, Medical, Graduate / organization & administration*
  • Emergencies
  • Female
  • Humans
  • Interprofessional Relations*
  • Male
  • Medical Staff, Hospital / psychology
  • Ontario
  • Patient Simulation
  • Power, Psychological*
  • Random Allocation