Experiences of pressure to conform in postgraduate medical education

Jan Grendar, Tanya Beran, Elizabeth Oddone-Paolucci

Perception of pressure to conform prevents learners from actively participating in educational encounters. We expected that residents would report experiencing different amounts of pressure to conform in a variety of educational settings. A total of 166 residents completed questionnaires about the frequency of conformity pressure they experience across 14 teaching and clinical settings. We examined many individual characteristics such as their age, sex, international student status, level of education, and tolerance of ambiguity; and situational characteristics such as residency program, type of learning session, status of group members, and type of rotation to determine when conformity pressure is most likely to occur. The majority of participants (89.8%) reported pressure to conform at least sometimes in at least one educational or clinical setting. Residents reported higher rates of conformity during informal, rather than formal, teaching sessions, p < .001. Also, pressure was greater when residents interacted with higher status group members, but not with the same or lower level status members, p < .001. Effect sizes were in the moderate range. The findings suggest that most residents do report feeling pressure to conform in their residency settings. This result is consistent with observations of medical students, nursing students, and clerks conforming in response to inaccurate information within experimental studies. Perception of pressure is associated with the setting rather than the trainee personal characteristics.