Behavioral Evidence of Clerks Conforming to Inaccurate Information: Surprising Findings


Beran T.N.
McLoughlin K.
Ma I. Alansar A. & Kassam A.A.


Trends in curriculum planning and development


Curriculum planning


University of Calgary


Although the development of collaborative relationships is considered a requirement for medical education (Martin, 2011), the functioning of these relationships may be impaired by a well-documented social-psychological phenomenon known as group conformity. Despite the intention of medical education to promote ethical, respectful, and valued relationships, we argue that personal motivations for group belonging may compromise the effectiveness of relationships within group contexts. In this study, we present empirical evidence of how conformity among final year medical students has an impact on their performance while learning a clinical procedure. The authors hypothesized that students would insert a needle into an incorrect location relative to the patella when performing a knee arthrocentesis if they believed that their peers had also inserted a needle in the same incorrect location.


This study provides behavioral evidence of students conforming to their peers’ incorrect performance of a clinical procedure. Indeed, conformity occurred in the absence of peers (i.e., they conformed to the past, rather than the present, performance of peers), which presumably exerts less pressure to conform. Moreover, conformity to the incorrect location occurred despite simultaneously verbalizing the correct insertion location. Returning to Martin’s call for the development of a professional identity in relationship to colleagues and patients (Martin, 2011), our study suggests that this type of medical education reform may be fraught with human emotional needs for acceptance and belonging. While these needs are not perilous, they may influence clinical behavior. The incidence of hospital medical errors is approximately 9%, with miscommunication as one of its causes (de Vries et al., 2008; Bartlett et al., 2008). We speculate that information may be mismanaged in a group situation where there is a strong need to “be a team player”, “collaborator” and where these terms are interpreted to mean one who agrees and “goes along” with group consensus. Indeed, “... [due to] a desire to maintain harmonious working relationships with colleagues, providers suppress their concerns about doing the right thing, and further distance themselves from having meaningful discussions about practices that will ensure safe and high quality care” (Henrikson & Dayton, 2006). Medical education reform must directly confront these tendencies and build into the curriculum strategies for communicating assertively and respectfully when encountering inaccurate or conflicting information.

Take-home Messages

During simulation, clerks aspirated a knee in a position they knew to be incorrect but did so in order to belong to their peer group.

Summary of Work

This was a randomized control study conducted in 2011 with 60 medical students (24 male; 40.0%) who were randomly assigned to either using a knee model that had a skin with holes left by needles in the wrong location or no marks in the skin. Each student’s aspiration site was measured with a fiberglass ruler to determine whether it was correctly located within the superior third, 1 cm medial to the patella. 

Summary of Results


Number (Proportion) of Students Aspirating in Each Site by Condition
  Experimental Control










Total 36 24


 The resear chers determined that students who used the marked skin were more likely to insert the needle in the incorrect location compared to those who used the clean skin (n = 31, 86.11% vs. n = 14, 58.33%), Fisher’s exact test (1) = 5.93, P = 0.03, Cohen’s d = 0.66.


 A sch SE. Opinions and social pressure. Sci Am. 1955;193:33-35.

Bartlett G, Blais R, Tamblyn R, et al. Impact of patient communication problems on the risk of preventable adverse events in acute care settings. CMAJ. 2008;178(12):1555-1562.

de Vries EN, Ramrattan MA, Smorenburg SM, et al. The incidence and nature of in-hospital adverse events: A systematic review. Qual Saf Health Care. 2008;17(3):216-23.

Henriksen K, Dayton E. Organizational silence and hidden threats to patient safety. Health Serv Res. 2006;41(4 Pt 2):1539-1554.

Martin C. Perspective: To what end communication? Developing a conceptual framework for communication in medical education. Acad Med. 2011;86:1566-1570.

Take-home Messages
Summary of Work
Summary of Results
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