The authors begin by noting that “Effective communication between team members is essential during the resuscitation of critically-ill patients. Failure of junior doctors to speak up and challenge erroneous clinical decisions made by their senior doctors is a serious communication failure which can result in catastrophic outcomes and jeopardize patient safety.” To evaluate this issue, they designed a study where 25 2^nd-year post-graduate ED physicians in Singapore went through a “high-fidelity simulated resuscitation scenario which was standardized to include faculty misdirection in the form of erroneous instructions given by a role-played senior doctor.” Because the authors wanted to see if the junior physicians would challenge erroneous instructions from physicians with greater authority, they did not reveal to them the true nature of the study. Instead, those physicians “were given the pretext that they will be participating in a mock code simulation scenario with the aim of enhancing their familiarity toward the ACLS protocols during their ED posting.”

  

The junior doctor participants were randomly divided into a control group and an intervention group. Both were given Advanced Cardiac Life Support (ACLS) training; the intervention group was also given crisis resource management (CRM) training. The simulations involved a high-fidelity mannequin and a 3-person resuscitation team, including the junior doctor and a nurse and senior physician, both of whom followed standardized scripts. The junior physicians were observed for how they responded—verbally and non-verbally—to erroneous instructions during the simulation, but the most telling data came out in the post-sim debriefs.