Managing Conflict Case: Admission of a Patient with Decompensated Schizophrenia, Hypertension, and Diabetes
ABSTRACT:
Audience: This practice Certifying Exam Communication case is intended for emergency medicine resident physicians (both junior and senior).
Introduction: Conflict is the result of two parties who differ in their expectations, agendas, personal needs, backgrounds, and/or communication styles. Emergency medicine physicians are faced with conflict in various forms in the workplace on a regular basis related to task content, interpersonal differences, and processes.1,2 When conflict is not managed appropriately, it can result in subpar patient care and poor team morale.3,4 Thus, conflict management is an important skill for all emergency medicine physicians. With this in mind, ABEM (the American Board of Emergency Medicine) has now chosen to assess candidates’ conflict management proficiency as part of its new Certifying Exam.5 As educators, we must prepare trainees for both the certification exam and the clinical setting by creating opportunities for practice, focused evaluation, and formative feedback. To strengthen our certifying exam preparation curriculum, we designed a certifying exam practice case to help residents learn how to manage conflict.
Educational Objectives: The following objectives, which align with ABEM’s recommended objectives, address the nuances of managing conflict. By the end of the session, learners should be able to: 1) demonstrate familiarity with the ABEM Managing Conflict case format and structure, 2) establish rapport by developing connection and trust with the admitting physicians, 3) demonstrate understanding of the other party’s position by verbalizing thoughtful and specific questions about his/her concerns, 4) explain his/her own position clearly and insightfully, 5) acknowledge divergent positions with thoughtfulness and insight, 6) identify interests shared by both the psychiatrist and hospitalist as well as what is in the best interest of the patient, and 7) propose a path forward which accounts for the interests of all parties involved.
Educational Methods: We developed a 10-minute OSCE (Objective Structured Clinical Examination)-style case requiring the resident examinee to manage a conflict with consulting physicians. The ABEM certifying exam will utilize standardized patient actors. For our case, the faculty examiner served as the actor who alternated between the two roles required by the case.
Research Methods: We piloted this case with 18 PGY-3 emergency medicine residents. We developed a grading rubric based on ABEM’s six published conflict-management case learning objectives. To pass the case, learners had to score 12 or more of the 18 available points (67%). Each learner was also asked to complete a post-case evaluation associated with a 5-point Likert scale.
Results: When asked whether the case increased their understanding of the new ABEM certifying exam format, 18/18 (100%) of the participants replied “agree” or “strongly agree.” When asked to assess the overall quality of the case, 16/18 (88.89%) of the participants stated that it was “very good” or “excellent.” The case received a mean score of 4.61/5. The mean critical action completion score was 17.61/18.
Discussion: We sought to create a practice certifying exam case that provided learners with a high-fidelity opportunity to both understand ABEM’s new certifying exam requirements and to be evaluated on how well they managed conflict. Our results reflect that most learners felt we addressed these aims, and that overall, our educational assessment was effective.
Topics: Conflict management, communication, certifying exam.
