Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 32727
Observations of Conformity in the Health Professions

Authors: Tanya N. Beran, Michelle A. Drefs, Ghazwan Altabbaa, Nouf Al Harbi, Noof Al Baz, Elizabeth Oddone Paolucci


Although interprofessional practice is a collaborative approach for problem solving among health professionals, its implementation can present challenges to its team members. In particular, they may feel pressured to agree with or conform to other members who share information that is contrary to their own understanding. Obtaining evidence of this phenomenon is challenging, as team members may underreport their conformity behaviors due to reasons such as social desirability. In this paper, a series of studies are reviewed in which several approaches to assessing conformity in the health care professions are tested. Simulations, questionnaires, and behavior checklists can be used to measure conformity behaviors. Insights from these studies show that a significant proportion of people conform either in the presence or absence of others, express a variety of verbal and nonverbal behaviors when considering whether to conform to others, may shift between conforming and moments later not conforming (and vice versa), and may not accurately report whether they conformed. A method of measuring conformity using the implicit bias test is also discussed. People at all levels in the healthcare system are encouraged to develop both formal and informal strategies to manage the conformity pressures that people face.

Keywords: Conformity, decision-making, interprofessional teams, medical simulation.

Procedia APA BibTeX Chicago EndNote Harvard JSON MLA RIS XML ISO 690 PDF Downloads 342


[1] K. Abbasi, “Three deadly sins: hierarchy, etiquette and conformity,” J R Soc Med, vol. 102, no. 11, p.455, 2009. doi:10.1258/jrsm.2009.09k061
[2] S. Asch, “Effects of group pressure upon the modification and distortion of judgments,” in Groups, Leadership and Men, H. Guetzknow (Eds.). Pittsburgh (PA): Camegie Press, 1951, pp. 177-190.
[3] S. Wheeler, H.F. Cline HF, “Personal response in divergent prison environments,” in The Scandinavian Prison Study, Palgrave Studies in Prison and Penology, D. Armor (Eds.). London UK: Palgrave Macmillan, 2020, pp. 205-222.
[4] B.H. Hodges, “Conformity and divergence in interactions, groups, and culture,” in The Oxford Handbook of Social Influence, Harkins, Stephen G., Kipling D. Williams, and Jerry Burger (eds), The Oxford Handbook of Social Influence, Oxford Library of Psychology (2017; online edn, Oxford Academic, 3 Nov. 2014),, accessed 7 Nov. 2022., 2017, pp. 87-105.
[5] R.B. Cialdini, N.J. Goldstein, “Social influence: compliance and conformity,” Ann Rev Psychol, vol. 55, pp. 591-621, 2003. n2004.pdf
[6] T.N. Beran, K. McLaughlin K, A. Alansari, A. Kassam. “Conformity of behaviors among medical students: impact on performance of knee arthrocentesis in simulation,” Adv Health Sci Educ, vol. 18, no. 4, pp. 589- 596, 2013. https://doi:10.1007/s10459-012-9397-5
[7] Organization for Economic Co-Operation and Development (OECD). Report on science and technology for a safer society, 2005. Retrieved from
[8] S. Nelson, J. Turnbull, L. Bainbridge, T. Caulfield, G. Hudon, D. Kendel, D. Mowat, L. Nasmith, B. Postl, J. Shamian, I. Sketris, Optimizing scopes of practice: new models for a new health care system. Canadian Academy of Health Sciences. Ottawa, Ontario, 2014.
[9] L.A. Dossett, C.A. Vitous, K. Lindquist, R. Jagsi, D.A. Telem, “Women surgeons’ experiences of interprofessional workplace conflict,” JAMA Netw Open, vol. 3, no. 10, pp. e2019843, 2020. doi:10.1001/jamanetworkopen.2020.19843
[10] M.A. Makary, M. Daniel, “Medical error—the third leading cause of death in the US,” BMJ, vol. 353, pp. i2139, 2016.
[11] K. Kaba, T.N. Beran, “The impact of peer pressure on the accuracy of reporting vital signs: an interprofessional comparison between nursing and medical students,” J Interprof Care, vol. 30, no.1, pp. 116-122, 2016. https://doi:10.3109/13561820.2015.1075967
[12] A. Kaba, T.N. Beran, D. White, “Accuracy of interpreting vital signs in simulation: an empirical study of conformity between medical and nursing students,” J Interprof Educ Pract, vol.3, pp. 9-18, 2016. https://doi:10.1186/s12909-017-1108-8
[13] J. Grendar, T.N. Beran, E. Oddone-Paolucci. “Experiences of pressure to conform in postgraduate medical education,” BMC Med Ed, vol. 18, no. 4, pp. 108, 2018.
[14] S. Ginsburg, E. Bernabeo, E. Holmboe, “Doing what might be “wrong”: understanding internists’ responses to professional challenges,” Acad Med, vol. 89, no. 4, pp. 664-670, 2014. https://doi:10.1097/acm.0000000000000163
[15] G. Altabbaa, T.N. Beran, A. Kaba, “Safety in numbers: are physicians really being "helpful" by going with the flow?” Acad Med, vol. 89, no. 12, pp. 1580-1581, 2014. https://doi:10.1097/ACM.0000000000000510
[16] R. Srivastava. “Speaking up-when doctors navigate medical hierarchy,” NEJM, vol. 368, pp. 302-305, 2013. https://doi:10.1056/NEJMp1212410
[17] P.M. Gollwitzer, J.D. Delius, G. Oettingen, “Motivation,” in International Handbook of Psychology, K. Pawlik and M. R. Rosenzweig (Eds.), London UK: Sage, 2000, pp. 191-206.
[18] D.M. Randall, M.F. Fernandes, “The social desirability response bias in ethics research,” J Bus Ethics, vol. 10, no. 11, pp. 805-817, 1991.
[19] Society for Simulation in Healthcare. The healthcare simulation dictionary. Available from: (Accessed January 16, 2020).
[20] H. Kelman, “Compliance, identification, and internalization: three processes of attitude change,” J Conflict Resolut, vol. 2, no. 1, pp. 51-60, 1958. doi:10.1177/002200275800200106.
[21] S. Sowden, S. Koletsi, E. Lymberopoulos, E. Militaru, C. Catmur, G. Bird, “Quantifying compliance and acceptance through public and private social conformity,” Conscious and Cogn, vol. 65, pp. 359-367, 2018.
[22] K. Mori, M. Arai, “No need to fake it: reproduction of the Asch experiment without confederates,” J Psychol, vol. 45, no. 5, pp. 390-397, 2010.
[23] B. Gillett, B. Peckler, R. Sinert, C. Onkst, S. Nabors, S. Issley, C. Maguire, S. Galwankarm, B. Arquilla, “Simulation in a disaster drill: comparison of high‐fidelity simulators versus trained actors,” Acad Emerg Med, vol. 15, pp. 15:1144-1151, 2008.
[24] S.K. Bell, R. Pascucci, K. Fancy, K. Coleman, D. Zurakowski, E.C. Meyer, “The educational value of improvisational actors to teach communication and relational skills: perspectives of interprofessional learners, faculty, and actors,” Patient Educ Couns, vol. 96, no. 3, pp. 381- 388, 2014. doi: 10.1016/j.pec.2014.07.001. Epub 2014 Jul 14. PMID: 25065327.
[25] T.N. Beran, M. Drefs, A. Kaba, N. Al Baz, N. Harbi, “Conformity of responses among graduate students in an online environment,” Internet High Educ, vol. 25, pp. 63-80, 2015. https://doi.10.1016/j.iheduc.2015.01.001
[26] N. Al Harbi, Assessment of conformity: instrument development. Doctoral dissertation, University of Calgary, Calgary, Canada, Retrieved from Dec. 2017
[27] N. Al Baz, An investigation of the relationship among conformity, communication, and anxiety in medical education. Doctoral dissertation, University of Calgary, Calgary, Canada, Retrieved from March 2019
[28] G.S. Berns, J. Chappelow, C.F. Zink, G.M. Pagnoni, E. Martin-Skurski, J. Richards, “Neurobiological correlates of social conformity and independence during mental rotation,” Biol P, vol. 58, no. 3, pp. 245-253, 2005. https://doi:10.1016/j.biopsych.2005.04.012
[29] J.S. Olver, M. Pinney, P. Maruff, T.R. Norman, “Impairments of spatial working memory and attention following acute psychosocial stress,” Stress Health, vol. 31, no. 2, pp. 115-123, 2015.
[30] S. Qin, E.J. Hermans, H.J. van Marle, J. Luo, G. Fernandez, “Acute psychological stress reduces working memory-related activity in the dorsolateral prefrontal cortex, “Biol Psych, vol. 66, pp. 25 – 32, 2009.
[31] S.Y. Rababa'h, K.H. Alzoubi, H.M. Hammad, L. Alquraan, K. El-Salem, “Memory impairment induced by chronic psychosocial stress is prevented by L-Carnitine,” Drug Des Devel Ther, vol. 13, pp. 4341-4350, 2019. doi:10.2147/DDDT.S225264
[32] H.J. van Marle, E.J. Hermans, S. Qin, G. Fernandez, “From specificity to sensitivity: how acute stress affects amygdala processing of biologically salient stimuli,” Biol Psych, vol. 66, pp. 649-655, 2009.
[33] P. Zhang, Y. Deng, X. Yu, X. Zhao, X. Liu, “Social anxiety, stress type, and conformity among adolescents,” Front Psychol, vol. 7, pp. 760, 2016. doi:10.3389/fpsyg.2016.00760
[34] G.L. Sculli, A.M. Fore, D.M. Sine, D.E. Paull, D. Tschannen, M. Aebersold, F.J. Seagull, J.P. Bagian, “Effective followership: a standardized algorithm to resolve clinical conflicts and improve teamwork,” J Healthc Risk Manag, vol. 35(a), pp.21-30, 2015. https://doi:10.1002/jhrm.21174
[35] C. FitzGerald, S. Hurst, “Implicit bias in healthcare professionals: a systematic review,” BMC Med Ethics, vol. 18, no. 1, pp. 19, 2017.
[36] A.G. Greenwald, D. McGhee, J.L.K. Schwartz, “Measuring individual differences in implicit cognition: the Implicit Association Test,” J Pers Soc Psychol, vol.74, pp. 1464–1480, 1998.
[37] P.F. Hewlin, “Wearing the cloak: antecedents and consequences of creating facades of conformity,” J Appl Psychol, vol. 94, no. 3, pp.727 – 741, 2009. doi: 10.1037/a0015228. PMID: 19450009.