Journal of Interprofessional Care

ISSN: 1356-1820 (Print) 1469-9567 (Online) Journal homepage: http://www.tandfonline.com/loi/ijic20

Impact of peer pressure on accuracy of reporting

vital signs: An interprofessional comparison
between nursing and medical students

Alyshah Kaba & Tanya N. Beran

To cite this article: Alyshah Kaba & Tanya N. Beran (2016) Impact of peer pressure
on accuracy of reporting vital signs: An interprofessional comparison between
nursing and medical students, Journal of Interprofessional Care, 30:1, 116-122, DOI:
10.3109/13561820.2015.1075967

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Published online: 01 Feb 2016.

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 JOURNAL OF INTERPROFESSIONAL CARE
2016, VOL. 30, NO. 1, 116–122
http://dx.doi.org/10.3109/13561820.2015.1075967

ORIGINAL ARTICLE

Impact of peer pressure on accuracy of reporting vital signs: An interprofessional

comparison between nursing and medical students
Alyshah Kaba and Tanya N. Beran
Medical Education and Research, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta,
Canada

ABSTRCT ARTICLE HISTORY

The hierarchical relationship between nursing and medicine has long been known, yet its direct Received 13 August 2014
influence on procedural tasks has yet to be considered. Drawing on the theory of conformity from Revised 14 June 2015
Downloaded by ["Queen's University Libraries, Kingston"] at 05:48 11 February 2016

social psychology, we suggest that nursing students are likely to report incorrect information in Accepted 21 July 2015
response to subtle social pressures imposed by medical students. Second-year medical and third-year KEYWORDS
nursing students took vital signs readings from a patient simulator. In a simulation exercise, three actors, Group conformity;
posing as medical students, and one nursing student participant all took a total of three rounds of vital interprofessional
signs on a high-fidelity patient simulator. In the first two rounds the three actors individually stated the collaboration;
same correct vital signs values, and on the third round the three actors individually stated the same interprofessional education;
incorrect vital sign values. This same procedure was repeated with actors posing as nursing students, and medical students; nursing
one medical student. A two-way analysis of variance (ANOVA) revealed that nursing student participants students; peer pressure;
simulation
(M = 2.84; SD = 1.24) reported a higher number of incorrect vital signs than did medical student
participants (M = 2.13; SD = 1.07), F (1,100) = 5.51, p = 0.021 (Cohen’s d = 0.61). The study indicated that
social pressure may prevent nursing students from questioning incorrect information within interprofes-
sional environments, potentially affecting quality of care.

Introduction programmes may be hindered by social factors. One such factor

is peer pressure that causes an individual to change his/her
Effective collaboration has been long recognized as a means to
behaviours to match those of the majority of group members –
achieve better quality of care and enhanced patient outcomes
even when the group members present incorrect information.
(Peterson et al., 2014; Reeves, Perrier, Goldman, Freeth, &
Known as conformity, this phenomenon has been studied in
Zwarenstein, 2013; Zwarenstein, Goldman, Reeves, 2009.). Yet,
social psychology over the last 60 years, but has yet to be
the way in which health professionals are socialized and trained
examined among interprofessional groups (Beran, Kaba, Caird,
continues to present significant barriers to collaboration (Hall,
& McLaughlin, 2014). Given that the social relationships
2005; Khalili, Hall, & DeLuca, 2014; Landman, Aannestad,
between medicine and nursing largely remain unexamined
Smoldt, & Cortese, 2014; Milne, Greenfield, & Braithwaite,
empirically, the overall objective of the present study is to deter-
2015). Globally, healthcare professionals are typically trained in
mine whether medical and nursing students enrolled in health
uniprofessional settings, independent of interprofessional edu-
professional programmes are likely to conform by giving incor-
cation (IPE) and collaboration, leading to challenges in practice
rect responses on a vital sign skills task upon hearing incorrect
(Hall, 2005; Khalili, Orchard, Laschinger, & Farah, 2013;
responses from group members of another profession.
Langendyk, Hegazi, Cowin, Johnson, & Wilson, 2015). A lack
of understanding and knowledge of others’ professional roles
and perspectives, along with “turf” wars and fear of “identity Conformity theory
loss”, have been cited as the main barriers to interprofessional
In a series of seminal studies, social psychologist Solomon
collaborative practice (Carpenter, Barnes, Dickinson & Woof,
Asch (1951) examined the phenomenon of group member-
2006; Chung et al., 2012; Khalili et al., 2014). The introduction of
ship on the behaviour of an individual member within the
IPE particularly at the pre-licensure level is a critical early inter-
group. When members of the group were instructed prior to
vention to enable students from two or more professions the
the experiment to provide the same incorrect response to a
opportunities to learn about, from, and with each other (CAIPE
line matching perception test, the individual who was unin-
(Centre for the Advancement of Interprofessional Education),
formed about the purpose of the study was more likely to
1997). Although reviews (Hammick, Freeth, Koppel, Reeves, &
provide the same incorrect response. These studies on group
Barr, 2007; Reeves et al., 2010; Reeves et al., 2013; Zwarenstein
conformity demonstrated that when an individual encounters
et al., 2009) have identified that IPE interventions can improve
information from the group that is contrary to his own under-
collaboration and healthcare outcomes, the effectiveness of IPE
standing, he is likely to revise his response to match that of

CONTACT Alyshah Kaba akaba@ucalgary.ca Medical Education and Research, Department of Community Health Sciences, Cumming School of Medicine,
University of Calgary, 3280 Hospital Dr. N.W., Calgary, AB, T2N 4Z6, Canada.
© 2016 Taylor & Francis

the group’s. This phenomenon has since been extended to
other approaches such as group think theory (Janis, 1972)
when examining decision-making among group members,
and also Crew Resource Management training (Helmreich,
Merritt, & Wilhelm, 1999) for pilots to learn interpersonal
communication skills in aviation. Peer pressure has only
begun to receive attention in medicine whereby Beran,
McLaughlin, Al Ansari, and Kassam (2012) determined that
medical clerks were more likely to perform a knee aspiration
incorrectly if they believed that their peer group had also
performed it incorrectly. This study provides emerging evi-
dence that clerks will improperly perform a clinical skill dur-
ing simulation when encountering peer pressure; it remains to
be determined whether conformity will occur within an inter-
professional context.
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In summary, conformity may be one factor that hinders
the ability of nurses and physicians to collaborate and com-
municate effectively. Considering that professional values and
impressions emerge at the pre-licensure level (Hallin,
Kiessling, Waldner, & Henriksson, 2009), the present study
is conducted with students. Specifically, we examine whether
nursing students are more likely to repeat incorrect informa-
tion from medical students, rather than the reverse. There are
three aims for this study. First, we will compare baseline vital
signs knowledge, skills and perception of skills between med-
ical and nursing students. Second, we will examine the vital
signs values they report. Third, given the socio-historical
relationship between the two professions, we will determine
whether nursing students are more likely to report incorrect
values than are medical students. With the emphasis on IPE
in health professional education, it is necessary to obtain
empirical evidence of how conformity might be implicated
in communication among health professionals to justify
future curriculum planning at the pre-licensure level.
Background
The interprofessional experience took place at an interprofes-
sional clinical simulation centre at a major university in
Canada. Upon arriving at the centre, students were told that
they would participate in a 45-minute simulation exercise in
which they would be required to take vital signs (radial pulse
(RP), respiration rate (RR), and blood pressure (BP)) on a
high-fidelity simulation mannequin (iStan©). While the facul-
ties of nursing and medicine both have a simulation area, the
advantage of selecting one closer to the hospital was to ensure
neither group of students was familiar with the setting. The
high-fidelity simulator uses the electronic software Muse©,
which has the capabilities of changing the systolic/diastolic
BP, RR, and RP read. The room had four video cameras that
recorded the students’ behaviours and interactions.
A standard protocol was developed to ensure the parti-
cipants did not interact with the confederates prior to the
start of session. The confederates received instructions from
the experimenter prior to the session to state specific
responses to these questions to standardize the process
across the four female/male nursing and medical groups.
The confederates used a separate entrance and were con-
cealed in a separate room between each of the study
JOURNAL OF INTERPROFESSIONAL CARE 117
sessions. When participants arrived at the simulation room
they were greeted by the experimenter and directed to the
simulation room, where two confederates were seated and
filling out forms. The participant was given some forms to
complete. The experimenter then left the room to retrieve
the last confederate. Once forms were completed, the
experimenter asked everyone to provide a brief introduc-
tion. They did so by identifying which university they were
from, their programme (nursing or medicine), and their
current clinical rotation placement. Subsequently, the stu-
dents watched a 5-minute instructional video developed by
the experimenter on the procedural steps to manually take
vital signs (available upon request to the first author). The
researcher consulted with both nursing and medicine
faculty to ensure these values and steps were consistent
with information taught by each of the programmes.
Finally, the participants were oriented to the mannequin
by the experimenter and given 10 minutes to practice taking
the vital signs on the simulation mannequin to ensure they
were familiar with the simulator’s function and were able to
obtain accurate readings.
The precise experimental procedures follow the original
Asch experimental design (Asch, 1951). Consistent with the
Asch design, the participant was the second last individual to
take the vital signs and report them aloud. The first two
confederates took three vital signs: RR, RP, and BP, and
then stated their findings consecutively to the group. The
participant, having heard the response of the two confederates
that preceded him/her, was then asked to state verbally the
values for RR, RP, and BP. Finally, the last confederate stated
the vital sign values. This process was repeated three times.
Prior to the experiment, researchers instructed the confed-
erates to state pre-determined vital sign values for all three
trials. For the first and second rounds the confederates all
gave the correct values for all three vital signs, but for the last
round, they all gave the same incorrect values for all three vital
signs: RR of 18 breaths/minute, RP of 70 beats/minute, and
BP of 115 mmHg/70 mmHg.
These values are considered wrong because they did not
match the readings that the mannequin had been prepro-
grammed to display. The correct response (as programed in
the patient simulator) for the RR was 24 breaths/minute, RP
was 52 beats/minutes, and BP was 135 mmHg/90 mmHg. In
maintaining a research design that closely approximates the
classic conformity studies, Asch (1951) established that parti-
cipants felt a sense of trust with the confederates during the
first two rounds, thus increasing their likelihood to conform
on the third round. Through simulation, we were able to
create a similar presence of social trust and rapport amongst
participants that would be analogous to the trust established
amongst interprofessional teams in healthcare. At the end of
the experiment, the participants were debriefed about the
purpose of the study and obtained consent for their
participation.
Methods
The present study examines peer pressure amongst medical
and nursing students using an experimental design that was
 118 A. KABA AND T. N. BERAN
consistent with the original experimental procedures (Asch,
1951).
Sample
A total of 104 second-year medical (n = 60) and third-year
nursing (n = 44) students participated in the study. This
sample size is adequate to detect a significant difference
between the two groups, based on an effect size of 0.70
(Cohen’s d), with a one-tailed probability criterion of 0.05,
and power at 0.90 (Cohen, 1988). This effect size was selected
because Bond and Smith (1996) reported a large effect size in
their meta-analysis. The sample of medical students (n = 30
male; n = 30 female) represents 35.29% of the total number of
medical students in the second-year class (n = 170). Also, the
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number of nursing students (n = 11 male; n = 30 female)
represents 15.60% of the total number of nursing students in
the third-year class (n = 282). We were unable to recruit a
larger sample of male nursing students, as there is a limited
population of men enrolled (n = 15). Second-year medical and
third-year nursing students were selected to ensure similar
exposure to the amount of clinical practice (approximately
two semesters) and number of simulated learning experiences
in their respective programmes.
Recruitment and randomization
Students from both faculties of nursing and medicine were
recruited through a multistage process (Kaba & Beran, 2014).
Students were not fully informed of the purpose of the study,
as this information would likely have impacted their beha-
viour during the session. Rather, during the recruitment phase
they were told that they would practice medical skills in a
simulation setting, while working with health professional
students from other professions.
Students were randomly assigned into four homogenous
experimental groups using a randomized block design. Given
Figure 1. Experimental groups.
that participant gender is related to conformity (Eagly & Carli,
1981), random assignment was conducted according to gen-
der to ensure an equal number of men and women per group.
Groups consisted of one medical student participant and three
actors posing as nursing students, or one nursing student
participant and three actors posing as medical students. In
each session there was one participant who was in the pre-
sence of three hired actors from the other profession. The
confederates were previously hired actors by the experimenter
who pretended to play the roles of these student group parti-
cipants (see Figure 1). Actors were recruited from outside of
the medical programme and received a total of six hours of
training to prepare them to accurately take vital signs. These
actors had not previously encountered either the nursing or
medical students and received a standardized script and vital
sign values to memorize. Although the use of confederates has
been described as a limitation in the literature as they may not
represent their peers (Crutchfield, 1955), recruiting nursing
and medical students to misinform their peers would have
been unethical and would make the experience unrealistic.
Having the students act in the role of confederates and know-
ingly “deceive” their own peer group would have potentially
put them in an uncomfortable situation and perhaps forced in
nature.
Measures
Demographic form
The demographic form included questions about gender, year
in the programme, and a question about confidence in taking
RR, RP, and BP on a 5-point scale where 1 = “not confident”,
2 = “somewhat confident”, 3 = “neither confident/or not
confident”, 4 = “confident”, 5 = “very confident”. Other
questions included the approximate number of times they
had used a high-fidelity simulation mannequin, the number
of semesters of clinical experience they had completed, and
current clinical placement or pre-clerkship rotation.

Knowledge questions
Participants were asked to complete nine knowledge questions
to ensure there were no differences in knowledge of vital signs
between medical and nursing students. The questions asked
participants to identify normal ranges for RR, RP, and BP
readings. A sample item includes, “which of the following
ranges is most likely considered normal resting radial
pulse?” Responses were: (a) greater than 100 beats per minute;
(c) 60–90 beats per minute; and (c) less than 60 beats per
minute. The minimum score for the nine knowledge ques-
tions is 0 and the maximum is 9.
Vital signs
Conformity was determined according to whether the parti-
cipant reported a vital sign the same as or close to the
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incorrect vital sign reported by the confederates.
Consultation took place with both nursing and medicine
faculty experts to confirm that the vital sign cut-off ranges
for conforming/not conforming were within educational stan-
dards (Simel, 2011). Responses were coded as correct (not
conforming) if they were within ±2 breaths/minute of the
correct value of 24 breaths/minutes for RR. The RP values
were marked accurate (not conforming) if the answer was
within ±4 beats/minute of the correct value of 52 beats/min-
ute. The systolic BP values were correct (not conforming) if
they were within ±4 mmHg of the correct value of 135 mmHg
and within ±4 mmHg of the correct diastolic BP of 90 mmHg.
Values outside of these ranges were coded as incorrect (con-
forming to confederates).
Data analysis
Descriptive statistics and frequencies were reported for all
variables, and skewness and kurtosis were used to examine
the shape and the distribution of the data. A multivariate
analysis of variance (ANOVA) was employed to determine
whether baseline knowledge, demographic, and practice char-
acteristics differed between medical and nursing students. The
total number of correct responses for the four vital signs was
compared between nursing and medical students using a two-
way ANOVA. A Chi-square analysis was used to determine
which of the four vital signs were the most frequently
reported incorrectly. Probability values, p < 0.05, were con-
sidered statistically significant.
Ethical considerations
The study followed the guidelines for behavioural research of
the American Psychological Association and was approved by
the University of Calgary Health Research Ethics Board.
Results
Demographic characteristics
A multivariate ANOVA determined that none of the demo-
graphic and practice characteristics differed between medical
and nursing students (p = 0.68) (Table 1). All students in both
groups took accurate vital sign readings during the practice
JOURNAL OF INTERPROFESSIONAL CARE 119
Table 1. Means and SDs of demographic and knowledge questions (n = 104).
Medical Nursing
Baseline characteristics students students
Age 27.43 (3.78) 26.48 (5.80)
Number of times practicing with a 2.72 (1.82) 2.75 (3.06)
simulator
Number of semesters of clinical 2.48 (1.27) 2.39 (1.04)
experience
Perceived confidence in taking RR 4.17 (0.67) 4.18 (0.58)
Perceived confidence in taking RP 4.50 (0.54) 4.36 (0.53)
Perceived confidence in taking BP 4.08 (0.67) 4.00 (0.43)
Knowledge questions (total correct) 8.80 (0.32) 8.50 (0.79)
session; thus, there were no differences in their skill level.
There was no significant difference in the participants’ per-
ceived confidence in taking RR, RP, and BP (p = 0.079).
Finally we determined that there was no significant difference
in baseline knowledge of vital signs between medical and
nursing students (p = 0.898). Thus, baseline demographic
and practice characteristics between the medical and nursing
students were similar.
Table 2 presents the values and frequency of each vital sign
(RR, RP, systolic, and diastolic BP) reported by all students.
About a quarter (27.0%) of the participants reported a RR
value that fell within the incorrect range of 16–20, as shown in
italics. All other participants reported an RR in the correct
range of 22–26. The most frequently identified value was 24,
which is the correct value, as shown in bold, followed by the
value of 18, which is the incorrect value reported by the
confederates, and is indicated in the table by the underline.
A similar pattern was found with RP with more than half
(63.6%) the total number of participants reporting the correct
response in the range 48–56. The most frequently endorsed
response was the incorrect value of 70 they heard reported by
the confederates.
A different pattern was observed for systolic and diastolic
BP. The large majority (87.5%) of participants reported a
systolic BP value in the incorrect range, with most responses
at the upper end of this range. For the diastolic BP, the
majority (72.1%) of participants were also likely to endorse
values within the incorrect range. Most students reported a
value of 80, which is halfway between the correct and incor-
rect values.
Differences between medical and nursing students
Overall, 95.2% of all students reported a value within the
incorrect range for at least one of the four vital signs.
Table 3 presents the mean/SD for each of the four vital
signs values reported by the medical and nursing students.
Since most of the variables are skewed (Tabachnick & Fidell,
1996), the Mann-Whitney U test was used. A Bonferroni
correction was applied to account for the multiple compar-
isons, with the new alpha set to 0.0125. Furthermore, a two-
way ANOVA revealed that nursing students (M = 2.84; SD =
1.24) reported a higher number of incorrect vital signs than
did medical students (M = 2.13; SD = 1.07), F (1,100) = 5.51, p
= 0.021, Cohen’s d = 0.61. No significant difference or inter-
action effect between male and female students (p = 0.571)
was found.
 120 A. KABA AND T. N. BERAN

Table 2. Frequency of vital signs values reported by students (n = 104).

Respiration rate Radial pulse Systolic BP Diastolic BP
Value N(%) Value N(%) Value N(%) Value N(%)
16.00 6(5.8) 48.00 2(1.9) 100.00 2(1.9) 70.00 15(14.4)
18.00 22(21.2) 50.00 16(15.4) 110.00 1(1.0) 72.00 4(3.8)
20.00 18(17.3) 52.00 14(13.5) 115.00 13(12.5) 74.00 2 (1.9)
22.00 10(9.6) 53.00 1(1.0) 116.00 1 (1.0) 75.00 2(1.9)
24.00 37(35.6) 54.00 18(17.3) 118.00 2 (1.9) 76.00 3(2.9)
25.00 1(1.0) 55.00 2(1.9) 119.00 1(1.0) 78.00 2(1.9)
26.00 10(9.6) 56.00 10(9.6) 120.00 10(9.6) 80.00 25(24.0)
66.00 6(5.8) 121.00 1(1.0) 82.00 8(7.7)
68.00 2(1.9) 122.00 3(2.9) 84.00 7 (6.7)
70.00 19(18.3) 124.00 1(1.0) 85.00 7(6.7)
72.00 12(11.95) 125.00 2 (1.9) 86.00 4(3.8)
74.00 2(1.9) 126.00 4(3.8) 88.00 7(6.7)
128.00 6 (5.8) 90.00 17(16.3)
130.00 44(42.3) 92.00 1(1.0)
132.00 7(6.7)
134.00 1(1.0)
135.00 4(3.8)
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138.00 1(1.0)
Notes. Incorrect value reported by confederates is underlined. Correct value programmed in the simulator is in bold. Incorrect range of responses is in italics. Correct
range of responses is in regular font.

Table 3. Mean (SD) of reported vital signs reported by medical and nursing
students.
Medical students Nursing students U statistics (df = 1)
RR 22.23 (2.69)a 20.84 (3.63)a 1,031.50*
RP 56.33 (6.73) 59.45 (8.19)a 1,037.00*
Systolic BP 128.35 (9.45) 123.77 (6.91)a 877.00*
Diastolic BP 84.13 (7.44) 79.71 (7.96) 830.00*
a
Skewed variables.
*Asterisk indicates significant at less than .0125.
Rate of conformity for each vital sign
To further understand which of the four vital signs the nur-
sing students most frequently reported incorrectly, four Chi-
square analyses were conducted. A Bonferroni correction was
applied to account for the multiple comparisons. Accordingly,
the new alpha was set to 0.0125. For RR, nursing students (n =
59.1%) were significantly more likely to provide incorrect
responses than were medical students (n = 33.3%), X2(1) =
6.83, p = 0.01 (Cramer’s phi = 0.26). Similarly for RP, nursing
students (n = 52.3%) were significantly more likely to provide
incorrect responses than were medical students (n = 30%), X2
(1) = 5.27, p = 0.001 (Cramer’s phi = 0.23). However, a
different pattern was observed for systolic BP, in which nur-
sing students (n = 90.9%) were not significantly more likely to
provide incorrect responses than were medical students (n =
85.0%), X2(1) = 0.81, p = 0.368. The same was observed for
diastolic BP, in which both nursing students (n = 81.8%) and
medical students (n = 65.0%) were likely to provide incorrect
values X2(1) = 3.57, p = 0.059. Thus, it appears that the
inaccuracy was more likely to be reported by nursing students
for respiration and RP, but not for BP. There was no signifi-
cant difference for gender of participant.
Discussion
Although all participants reported correct vital signs in the
practice round, the vast majority of participants reported at
least one incorrect value upon hearing group members report
incorrect values. This demonstrates a surprisingly high rate of
conformity. In addition, we found that nursing students were
more likely to conform than did medical students, in parti-
cular when reporting RR and RP. For systolic and diastolic
BP, medical students were as likely to conform.
Our empirical evidence supports other work that have
identified the entrenched hierarchies between nursing and
medicine (Hall, 2005; Langendyk et al., 2015; McInnes,
Peters, Bonney, & Halcomb, 2015; MacMillan, 2012; Price,
Doucet, & Hall, 2014; Stein, Watts, & Howell, 1990; Stein,
1967). The nature of this dominant, subordinate relationship
was effectively coined by Stein’s (1967) seminal paper on the
interprofessional dynamics as the “doctor–nurse game”.
Although the relationship between the two professions has
become more collegial over time, the educational system in
which physicians and nurses are trained may instil through
the informal curriculum omnipotence in medical students and
subservience in nursing students (Burford et al., 2013;
Gilligan, Outram, & Levett-Jones, 2014; MacMillan, 2012;
Price et al., 2014). Furthermore, medical students are also
socialized within environments that perpetuate an under-
standing that physicians play a superior role in patient care
decision-making, which can impede interprofessional respect
and collaboration (Price et al., 2014; Stein et al., 1990).
Our findings suggest that group conformity behaviours dur-
ing interprofessional interactions may have critical implications
for these existing hierarchical relationships between the two
professions. This differential may contribute to moral distress
– a phenomenon describing the experience of cognitive-emo-
tional dissonance that arises when an individual feels compelled
to act contrary to one’s moral requirements (Berger, 2014;
Papathanassoglou et al., 2012). Nurses may feel reluctant to
speak up about physicians’ opinions, believing that their opi-
nions would not be accepted (Papathanassoglou et al., 2012).
Thus, the nursing students in our study may have been experi-
encing feelings of moral distress when taking vital signs with
medical students who reported values that did not match the
vital signs they took from the mannequin. This may explain
why they were more likely to conform to a higher number of
vital signs than did the medical students.

Although the nursing students were more likely to con-
form overall and for RR and RP in comparison to medical
students, this difference was not found for BP. This can be
explained by the fact that so many of the medical students
also conformed on BP – with over half and three quarters
reporting incorrect values for systolic and diastolic values,
respectively. This may be explained by the cognitive load
theory (Paas & Van Merriënboer, 1994). Accordingly, infor-
mation received into the brain must be processed in working
memory (Kavic, 2013), which is limited in the amount of
discrete information – “chunks” of information that can be
retained at once. All information in working memory must be
encoded and transferred to long-term memory, before mean-
ingful learning can continue (Kavic, 2013). BP involves more
complex measuring techniques compared to other vital signs
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(Armstrong, 2002), as the participant has to first place the
diaphragm of the stethoscope over the brachial pulse, close
the valve on the air pump, and inflate the cuff until the gauge
reaches 200 mmHg. Then the cuff has to be slowly deflated at
a constant rate (2 mmHg per second) while also watching the
sphygmomanometer and listening with the stethoscope to
record the first and last heartbeat sounds. The first sound of
a heartbeat is recorded on the sphygmomanometer as the
systolic pressure reading (e.g.135 mmHg) and the last sound
of the heartbeat is recorded on the sphygmomanometer as the
diastolic pressure reading (e.g. 90 mmHg). All these steps
require reading and remembering many numbers. This com-
plexity could have created uncertainty about the correct
answer; thus, both medical and nursing students may have
relied on the group’s responses for this particular vital sign.
Perhaps the most surprising result from our study was that
the large majority of participants reported at least one value in
the incorrect range. That is, one quarter of the participants
selected a diastolic BP value of about 80 and between the
correct value of 90 and the incorrect value of 70, which was
reported by the confederates. One possible reason is that the
confederates’ value provided an anchor that pulled the partici-
pants’ score in that direction, resulting in a “hovering effect”
midway between the correct and incorrect values. This middle
area may have seemed socially safe to report. This could be
explained by social referencing, whereby individuals utilize
others’ appraisals of events to formulate their own interpreta-
tions of those events (Feinman, 1982). Social referencing is
heightened when there is ambiguity or uncertainty which
others’ evaluations help to reduce (Zarbatany & Lamb, 1985).
In our study, perhaps the reason the participants reported a
value that was halfway between the correct and incorrect value
for the diastolic BP was that the value of 80 represented an
invisible border or “reference” of what the participant per-
ceived as socially safe to report. As the participants gained
information from their social environment, they may have
looked to each other as familiar and trusted figures for gui-
dance in their actions (Zarbatany & Lamb, 1985). Since indivi-
duals learn their behaviour through observation and imitation
of peers, the participants in our study may have felt a sense of
trust with the confederates during the first two rounds, thus
increasing their likelihood to conform on the third round.
In relation to study limitations, this work was restricted to
one university; thus, the results may not be generalizable to
JOURNAL OF INTERPROFESSIONAL CARE 121
other sites. It only included students who volunteered to parti-
cipate. It is also possible that the participants, who value IPE,
may have been more likely to sign up. We were unable to
recruit a larger sample of male nursing students, as there are
a limited number of men enrolled in the programme (n = 15).
However, because the participants represented the population
of students, the findings may be applicable locally. In addition,
participants may have acted differently in a simulation envir-
onment than within a clinical setting; thus, further studies
should be conducted in a clinical context. Finally the students
may have informed other students about the study, which
could have affected the later participants’ performance. All
students, however, were asked if they were aware of the study,
and no one reported having been informed.
Concluding comments
Given the hierarchical relationships between the two profes-
sions, IPE programmes need to ensure that all students are
encouraged to question, and politely challenge what seems to
be incorrect information. To improve teamwork and colla-
boration between medicine and nursing, interprofessional
curricula need to include the promotion of shared interpro-
fessional responsibility, open dialogue, and joint decision-
making to improve the quality of patient care (Pian-Smith
et al., 2009). Given the initial evidence that medical and
nursing students are likely to conform on vital skill task and
the reproducibility of similar results across different samples
and settings from recent conformity studies (Beran, Drefs,
Kaba, Al Baz, & Al Harbi, 2015; Beran et al., 2012; Kaba, &
Beran, White, in press), replication with clinicians, different
clinical skills, and complex team decision-making are called
for, to explore the consistency of this phenomenon across
different study designs and contexts.
Acknowledgements
We would like to acknowledge the following sources of support: Ward of
the 21st Century (W2IC); Undergraduate Medical Education
Standardized Patient Program; Faculty of Nursing University of
Calgary and Undergraduate and Medical Education Department,
University of Calgary, Canada.
Declaration of interest
The authors report no conflicts of interest. The authors alone are
responsible for the writing and content of this article.
Funding
This study was supported by the Social Sciences and Humanities
Research Council grant # 430-2011-0032.
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