Managing Conflict Case: The Difficult Consultant
Correspondence should be addressed to Stephanie Stapleton, MD at snstaple13@gmail.com
DOI: https://doi.org/10.21980/J8.53815
ABSTRACT:
Audience: This communication case is intended for emergency medicine (EM) resident physicians and junior faculty preparing for the ABEM Certifying Exam.
Introduction: Conflict management is a common and significant challenge in the emergency department (ED), with potential negative impact on both physicians and patients. At the individual level, hospital-based conflicts can lead to emotional stress, impaired concentration, decreased trust among providers, and feelings of dehumanization.¹ For patients, conflicts between physicians can compromise the quality of care and contribute to delays in treatment.¹ In the ED, conflict often arises between emergency physicians (EPs) and various stakeholders, including patients, family members, nursing staff, hospitalists, and consultants.² Recognizing its importance, the American Board of Emergency Medicine (ABEM) has identified conflict management as a core competency for emergency medicine residents and has incorporated it into the oral certification examination.³ This oral examination case was developed to help train EM residents in managing conflict—specifically between an emergency physician and a consultant—in a structured environment.
Educational Objectives: By the end of the session, the learner should be able to: 1) review format and have become familiar with an ABEM Certifying Exam conflict management communication case, 2) demonstrate the ability to initiate the consultation call, establish rapport, and present a concise, evidence-based summary of the patient’s STEMI findings, 3) recognize concerns raised by the cardiologist and respond with an empathetic acknowledgment (eg, validating workload, uncertainty, or resource constraints) to support a collaborative tone, 4) articulate differing viewpoint by referencing objective clinical data (eg, ST-segment elevations, ongoing chest pain, risk from delays) when conflict is encountered and justify why urgent catheterization lab activation is indicated, and 5) identify shared goals in optimizing patient care (reducing myocardial damage and preventing deterioration) and use these to negotiate a mutually acceptable plan.
Educational Methods: This is a standardized patient scenario in alignment with the expected Managing Conflict case format of the ABEM Certifying Exam. The benefits of this educational modality are that it allows for direct observation and assessment of a learner’s ability to communicate with a consultant and to observe the use of conflict resolution strategies.
Research Methods: We used an iterative case trialing process with a convenience sample of EM residents. Feedback from each site was used to make iterative changes to the case material. Facilitators completed a Simulation Scenario Evaluation Tool4 (SSET) survey during the written and alpha trials to evaluate the quality of key simulation elements. Facilitators and learners used modified usability surveys to evaluate cases during the beta trials. All surveys were completed anonymously using 5-point Likert scales and free text responses. All data were collected using Qualtrics (https://www.qualtrics.com) and analyzed using Excel (Microsoft, Redmond, WA). The Boston University Institutional Review Board reviewed the project and deemed it exempt.
Results: A total of 14 senior resident learners and 4 facilitators evaluated the case. The SSET data were largely positive; case objectives, key actions and materials were clear. The facilitators found the case was easy to use, and thought others would feel similarly. They felt confident using the case and would like to use this case for ABEM certifying exam practice. Over 90% of residents found both the written and verbal case materials to be clear. Ninety percent of residents reported that the experience was helpful practice for the ABEM certifying exam.
Discussion: The case was well-received by both learners and facilitators due to its realism and similarity to real-life encounters and appears to be a useful preparatory tool for the ABEM Certifying Exam’s Managing Conflict case because it allows learners to practice conflict resolution skills.
Topics: Conflict resolution, communication, ABEM Certifying Exam.
