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

Summary 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.