Nothing will stop someone who's disagreeable, assertive, non-conscientious AND given unchecked status from ignoring a step for capricious reasons. But medical

Nothing will stop someone who's disagreeable, assertive, non-conscientious AND given unchecked status from ignoring a step for capricious reasons. But medical school is going to heavily select for conscientiousness (a personality trait that checklists work with), and also checklists are essentially another authority in the room. So, yes, you could potentially have discussions over whether or not something has actually been done. But you aren't going to have discussions about whether it should be.