Postgrad Med J 87:323-324 doi:10.1136/pgmj.2010.109298
  • Editorial

The dissenting opinion: can simulation-based multi-professional training reduce ‘groupthink’?

  1. Greg McAnulty
  1. St George's Advanced Patient Simulator (GAPS), St George's Healthcare NHS Trust, London, UK
  1. Correspondence to Huon Snelgrove, St George's Advanced Patient Simulator (GAPS), St George's Healthcare NHS Trust, Blackshaw Road, London SW17 0QT, UK; huon.snelgrove{at}
  1. Contributors GM had the idea for the editorial and worked closely with HS, who examined the literature and wrote the initial drafts. The final version was written jointly by GM and HS. NG contributed comments on the final draft.

Ethical decision-making and effective team working are at the core of medical professionalism and patient safety. But new concepts of patient autonomy may be at odds with traditional views of the primacy of preserving life,1 and maintaining a focus on patient safety within complex clinical environments is evermore challenging. These two fields are under-developed and under-theorised in medical education.2

What is lawful may not be seen as ethical; and what professionals regard as ethical may not be lawful. New nurses and doctors have to learn different ways of doing things and to do them with new people. The rules of play are often unwritten. Investigating what people ‘know’ and ‘do’ is difficult as well. Neurocognitive scientists suggest that self-reported and predicted behaviours often can be at odds with actual and observed decisions.3

Contemporary analyses of learning, especially work-based social learning theory4 and social complexity,5–7 may help us improve on how teamwork relates to patient safety. Such models stress adaptation through collaboration and the need to gather and share knowledge continuously.8 A key tenet of complexity theory is that diversity is useful in handling complex variable tasks. Including people who think and do things differently can bring different approaches to processing information.9

The need for acute care clinical teams to maintain ‘situational awareness’ is an example. The avoidance of entrained thinking (an acute form of ‘groupthink’10) is an important component. Encouraging, listening to and valuing dissenting opinion may be the most important characteristic of teams that act in a patient's best interest. That a …