Addressing groupthink in interprofessional clinical simulation

Interprofessional education (IPE) is designed to foster collaboration among health care professionals, yet issues like groupthink—a phenomenon where the desire for group consensus overshadows critical thinking—can hinder its effectiveness. In prior simulations,1 potential groupthink was identified as a significant barrier to effective decision-making, leading to decreased metacognitive accuracy (alignment of confidence with actual performance). This issue was likely compounded by a lack of metacognitive awareness among participants, with teams converging on incorrect ideas within shared mental models (SMMs), thus compromising clinical judgment. The challenge was to address this convergence toward error, enhance decision-making processes and improve metacognitive accuracy in interprofessional settings. A targeted intervention was implemented during a second iteration of an interprofessional clinical simulation involving 96 participants from medical (37), nursing (44) and pharmacy programmes (18) in groups of 5–6. The simulation centred around the management of a critically ill ICU patient with multiple comorbidities. Participants received a structured orientation highlighting the risks of groupthink and strategies to promote independent, critical thinking. This session also emphasised metacognitive independence within clinical teams and its role in clinical decision-making. Participants were trained to critically assess their own confidence and the accuracy of their knowledge when making group decisions within their own professional scope of knowledge. Participants completed a set of multiple-choice questions (MCQs) related to the simulation case, including both profession-specific questions and questions from the other professional domains. This resulted in students of a particular profession responding to questions from their own profession and the professions of others in the team. This established a baseline across professions included within the team, for participants' knowledge, confidence and calibration (level of metacognitive accuracy). Interprofessional teams of medical, nursing and pharmacy students collaborated to manage the ICU patient's care. Throughout the simulation, participants may have applied the metacognitive strategies from the orientation to ensure they evaluated their individual expertise and the contributions of others critically. Following the simulation, participants completed the same set of MCQs to evaluate changes in their knowledge, confidence and calibration as a result of their simulation experience. Subsequently, a comprehensive debriefing session facilitated by faculty encouraged reflection on group dynamics and domains of patient care within the simulation. The intervention produced significant improvements in several areas. Post-simulation assessments revealed marked enhancements in confidence judgment ratings and metacognitive accuracy across professional cohorts. Importantly, the convergence toward error observed in previous sessions was no longer evident, suggesting that the structured orientation successfully mitigated the pressures of groupthink. Participants appeared to have demonstrated more balanced and independent decision-making, with greater alignment between their confidence and actual performance. This study demonstrates that addressing cognitive biases like groupthink and understanding the need for metacognitive independence in IPE settings can improve the effectiveness of IPE, likely better preparing students for collaborative practice in real-world clinical settings. Conceptualization: Colin Greengrass and Val Kozmenko. Data curation: Val Kozmenko, Andrew Guymon and Jared Hueser. Formal analysis: Val Kozmenko, Colin Greengrass, Andrew Guymon and Jared Hueser. Funding acquisition: None. Investigation: Val Kozmenko. Methodology: Colin Greengrass and Val Kozmenko. Project administration: Val Kozmenko. Resources: Val Kozmenko. Software: None. Supervision: Val Kozmenko. Validation: None. Visualization: None. Writing—original draft: Colin Greengrass. Writing—review and editing: Colin Greengrass. The research team would like to acknowledge the faculty and staff of the University of South Dakota Sanford School of Medicine and Nursing Program, the Parry Center and the Cardiology Fellowship Program, including its fellows and administration. We also extend our gratitude to the standardized patients, the South Dakota State University Pharmacy Program and all learners for contributing to the success of this project. The authors declare that there are no conflicts of interest regarding the publication of this article. The data that support the findings of this study are available from the corresponding author upon reasonable request.