{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T22:21:18Z","timestamp":1791152478376,"version":"4.1.0"},"reference-count":34,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2008,6,28]],"date-time":"2008-06-28T00:00:00Z","timestamp":1214611200000},"content-version":"vor","delay-in-days":1305,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2004,12]]},"abstract":"<jats:p>\n                    The term \u201cauthority gradient\u201d was first defined in aviation when it was noted that pilots and copilots may not communicate effectively in stressful situations if there is a significant difference in their experience, perceived expertise, or authority. A number of unintentional aviation, aerospace, and industrial incidents have been attributed, in part, to authority gradients. The concept of authority gradient was introduced to medicine in the Institute of Medicine report\n                    <jats:italic>To Err Is Human<\/jats:italic>\n                    , yet little has been written or acknowledged in the medical literature regarding its role in medical error. The practice of medicine and medical training programs are highly organized, hierarchical structures that depend on supervision by authority figures. The concept that authority gradients might contribute to medical error is largely unrecognized. This article presents one case and a series of examples to detail how authority gradients can contribute to medical error, and describes methods used in other disciplines to avoid their potentially negative impact.\n                  <\/jats:p>","DOI":"10.1197\/j.aem.2004.07.005","type":"journal-article","created":{"date-parts":[[2004,12,2]],"date-time":"2004-12-02T14:27:59Z","timestamp":1101997679000},"page":"1341-1345","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":173,"title":["<i>Profiles in Patient Safety:<\/i>\n                    Authority Gradients in Medical Error"],"prefix":"10.1111","volume":"11","author":[{"given":"Karen S.","family":"Cosby","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pat","family":"Croskerry","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2008,6,28]]},"reference":[{"key":"e_1_2_1_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006454-199507000-00007"},{"key":"e_1_2_1_3_1","first-page":"pp. 180","volume-title":"To Err Is Human: Building a Safer Health System Institute of Medicine Report","author":"Kohn LT","year":"2000"},{"key":"e_1_2_1_4_1","volume-title":"Longitude The True Story of a Lone Genius Who Solved the Greatest Scientific Problem of His Time","author":"Sobel D","year":"1995"},{"key":"e_1_2_1_5_1","volume-title":"Stress and the airline pilot. 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