Assessment of Conformity: Instrument Development
Creators: name: Al Harbi, Nouf Sulaiman
Publisher: name: Cumming School of Medicine
Year: 2018
Subjects: subject: Peer pressure
subject: Group conformity
subject: Medical Education
subject: Education
subject: Medical students
subject: Simulation
subject: Interprofessional education
subject: Interprofessional collaboration
subject: Nursing students
subject: Educational Psychology
subject: Biophysics--Medical

description: Current educational systems, including medical programs, incorporate learning in groups. However, subtle social factors functioning within these groups can influence learning and professional development. Thus, these social factors should be considered by both educators and learners. One social factor that has gained the attention of medical educators is conformity. Conformity is submission to the pressure of the group or its members and is represented by changing one’s behaviour, attitudes or beliefs to align with those of the group. It is associated with peer pressure and hierarchy whereby the need to be accepted within a professional milieu is paramount. Hence, conformity could prevent learners from actively engaging (e.g., asking questions) in education. Moreover, conformity has been associated with learners reporting feeling overwhelmed, and it has contributed to information mismanagement, inaccurate decision-making, and learners inefficiently using health care resources or compromising their role as patient advocates. The eventual outcome is deterioration in the provision of health care. The aim of this study was to create an instrument that enables both learners and educators to track verbal and nonverbal behaviours that are indicative of conformity. An observational cross-sectional design was used in three phases in this study. In Phase I, an initial conformity instrument was created based on behaviours identified in the communication, social psychology, and medical education literature and through discussion with conformity experts. The researcher then used this instrument in Phase II to code archival videos of the conformity behaviours of medical and nursing students from a prior study on conformity. Finally, in Phase III the instrument was used in real-time simulation sessions to record the behaviours of medical residents and students who were given the challenge of managing a patient case. This case was designed to expose the medical residents and students to pressure that would potentially influence their clinical decision making. Also, this study examined whether conformity as a construct is uni- or multidimensional. The study results showed that the instrument’s scores did not differentiate conforming from nonconforming behaviours. Also, the principal component analysis generated uninterpretable results, suggesting that the behaviours measured are not multidimensional. Participants also shared their perspectives about conformity, and revealed that they viewed conformity as a natural dynamic in their daily practice and could potentially yield to the pressure of the group or their senior colleagues when faced with a conflict. The implications for teaching and practice are discussed. It is also recommended that further research examine conformity in clinical settings to determine if the results obtained in clinical simulations are consistent with practice.