Power Distance Impacts Surgical Staff and Patients

We read with great interest the important study by Teo et al.¹ demonstrating that moral distress rounds can provide a zone of psychological safety for surgical residents, allowing them to navigate various nontechnical human and ethical factors that impact their delivery of surgical care. When attempting to mitigate moral distress and improve psychological safety amongst surgical staff, it is important that power dynamics are integrated, given they are an important human factor affecting the multidisciplinary care model of surgical patients. Within a healthy surgical culture, surgical hierarchies can promote efficiency and benefit patient care, as roles are clearly delineated. However, when power imbalance exists, a junior, such as the residents in Teo et al's study,¹ may find it challenging to be an active member of the team; making authority bias, flawed communication, and errors more likely to occur.