1. Experiences, Influences, and Outcomes
On average, in the last week during training participants reported experiencing situations where they conformed to peers behaviour 3.2 times and were obedient to an authority 2.3 times (Table 3).
The majority of the sample (84.6%) indicated they had carried out a task in the way a peer did when uncertain of the proper method; participants indicated they had often observed peers do the same (91%). When performing a procedure or technique participants felt peers frequently went with the crowd (53%) at a higher rate than themselves (27%), most participants (60%) believed they only sometimes went with the crowd. Participants tended to feel somewhat confident in their knowledge when a peer disagreed with them (79%), a minority (6%) were completely confident.
Almost all participants (91%) had been in a situation where they followed the instruction of an authority feeling that they could not contradict the person despite believing the person in authority to be incorrect. An equal number had a peer disclose being in a similar situation. Most participants (81%) indicated they had followed peers that were acting on instruction from an authority that the participant did not believe to be correct. Fifty-one percent of participants had been subjected to negative consequences for speaking up and 65% had witnessed peers being subjected to negative consequences for speaking up.
Table 3 Mean number of experiences with conformity and obedience
Time Frame
|
Conformity
|
Obedience
|
|
Self
|
Peer
|
Self
|
Peer
|
Past Week
|
3.2(2.2)
|
4.83(2.74)
|
2.29 (2.5)
|
2.57(2.4)
|
Past Month
|
8.11(4.96)
|
10.63(5.7)
|
4.33(3.9)
|
5.39(4.0)
|
Past Six Months
|
23.5(12.83)
|
26.75(17.53)
|
11.77(11.79)
|
16.2(12.96)
|
Note: Standard deviations are shown in parentheses.
Participants indicated Impression Management was a factor for obedience and conformity. Sixty-nine percent of participants had acted on incorrect instructions from an authority because of concern with how the authority would perceive them personally, with 68% reporting concern with how they would be perceived professionally. Participants indicated a high level of concern with being viewed as a typical member of their profession (60%) yet to a lesser degree indicated a high level of concern with how peers would view them professionally (35%), a small number (10%) were never concerned with how others thought of them. Most participants felt it necessary to alter their behaviour (89%) and thinking (67%) to align with the behaviour and thinking of those around them. Almost all participants felt a need to “fake it until you make it” (94%) with many feeling that they often needed to do so (37%).
Displacement of Responsibility was frequently indicated as a factor in obedience with 66% of participants having followed the instructions of an authority because they did not believe that they themselves would be held personally responsible for the outcome.
Being obedient to an authority caused Moral Distress for participants. Acting on the instructions of an authority believed to be incorrect had caused distress for most participants (71%), with 51% having felt highly distressed and 13% extremely distressed. Similar distress was witnessed in peers (73%), with participants reporting peers had indicated they had been highly distressed (53%) and extremely distressed (6%).
2. Perceptions of Compliance
Responses to the open-ended item provide further insight into participant experiences. Four primary themes were identified in the responses: Desire for Smooth Interactions, Student-Instructor Dynamic, Experience and Knowledge as Supportive Factors, and Need for Education on Positive Deviance.
Desire for Smooth Interactions
Several of the participants stated that the avoidance of conflict and a desire for smooth interactions was a central reason to obey authority figures. Some participants stated that they often go along with what the instructor says for the purposes of assessment. Participants behavior or actions would adapt for the clinical environment, but it is not ‘worth it’ to them to question their instructor’s actions.
“I think that sometimes we may go with what an instructor says just because that is the way we are supposed to do it for the purposes of the course. Rather than speak out against what we think might not be the best way of doing something, we just learn it for the test and know we won't actually do it that way in practice”
(20-25-year-old, Occupational Therapy Student)
“One reason that I obey authority figures is that I do not want to start a loud argument or 'create a scene’”
(20-25-year-old, Dietetics Student)
Student-Instructor Dynamic
Participants mentioned the nature of the student-instructor relationship creates a power differential that creates discomfort with questioning authority.
“I find that power dynamics (e.g. Those between a senior faculty member and a student) make it very difficult to feel comfortable or able to question the authority figure. Conformity is often very hard to avoid in that sense, I have found.”
(20-25-year-old, Kinesiology Student)
Experience and Knowledge as Supportive Factors
Students believed more experience and knowledge were a means to counterbalance obedience to authority. Having the confidence and comfort level to speak up and ask questions within a specific context was mentioned.
“I feel like a lot of my obedience was in years past and now I do feel more comfortable asking questions and clarifying before I do something. This is typically based on experience in the area.”
(26-30-year-old, Occupational Therapy Student)
Need for Education on Positive Deviance
A few participants expressed a need for education on dealing with situations of obedience, two forms of need were identified. First, participants commented that teaching students how to engage instructors who don't want to hear opposing ideas would better prepare students to manage situations where they need to question authority in potentially conflictual situations. Second, participants desire faculty development and education for instructors about positive deviance and the need to encourage questions and opposing beliefs from students to counteract obedience and create a learning space that allows for open discussion.
“It is difficult to say no or to oppose the beliefs of instructors that do not know how to handle hearing what they don't want to hear. More needs to be done to educate students on how to handle these conflicts.”
(20-25-year-old, Physiotherapy Student)
The participants written comments indicate that students have experienced issues of obedience in the educational setting yet have found strategies to avoid the situation when they did arise. With time (experience) and greater knowledge, they felt the frequency and/or impact of these situations would lessen.