The Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Ontario.
Acad Emerg Med. 2014 Mar;21(3):308-13. doi: 10.1111/acem.12325.
The objective was to determine the causes of and mitigating factors for conflict between emergency physicians and other colleagues during consultations.
From March to September 2010, a total of 61 physicians (31 residents and 30 attendings from emergency medicine [EM], internal medicine, and general surgery) were interviewed about how junior learners should be taught about emergency department (ED) consultations. During these interviews, they were asked if and how conflict manifests during the ED consultation process. Two investigators reviewed the transcripts independently to generate themes related to conflict until saturation was reached. Disagreements were resolved by consensus. The trustworthiness of the analysis was ensured by generating an audit trail, which was subsequently audited by an investigator not involved with the initial analysis. This analysis was compared to previously proposed models of trust and conflict from the sociology and business literature.
All participants recalled some manifestation of conflict. There were 12 negative conflict-producing themes and 10 protective conflict-mitigating themes. When comparing these themes to a previously developed model of the domains of trust, each theme mapped to domains of the model.
Conflict affects the ED consultation process. Areas that lead to conflict are identified that map to previous models of trust and conflict. This work extends the current understanding about intradisciplinary conflict in the clinical realm. These new findings may improve the understanding of the nature of conflicts that occur and form the foundation for interventions that may decrease conflict during ED consultations.
确定急诊医师与其他同事在会诊期间发生冲突的原因和缓解因素。
2010 年 3 月至 9 月，共有 61 名医师（急诊医学、内科和普通外科的 31 名住院医师和 30 名主治医生）接受了关于应如何向初级学习者教授急诊科会诊的访谈。在这些访谈中，他们被问到冲突是否以及如何在急诊科会诊过程中表现出来。两名调查员独立审查转录本以生成与冲突相关的主题，直到达到饱和。通过达成共识解决分歧。通过生成审计线索来确保分析的可信度，随后由未参与初始分析的调查员对其进行审核。将此分析与社会学和商业文献中提出的信任和冲突模型进行比较。
所有参与者都回忆起一些冲突的表现。有 12 个产生负面冲突的主题和 10 个缓解冲突的主题。将这些主题与之前开发的信任领域模型进行比较时，每个主题都映射到模型的领域。
冲突会影响急诊科的会诊过程。确定了导致冲突的领域，这些领域映射到之前的信任和冲突模型。这项工作扩展了关于临床领域内部分歧的现有认识。这些新发现可能有助于更好地了解冲突的性质，并为减少急诊科会诊期间冲突的干预措施奠定基础。
