From the Departments of Anesthesiology.
Orthopaedics and Rehabilitation, University of Florida College of Medicine, Gainesville, Florida.
Anesth Analg. 2018 Oct;127(4):1028-1034. doi: 10.1213/ANE.0000000000003432.
Successful conflict resolution is vital for effective teamwork and is critical for safe patient care in the operating room. Being able to appreciate the differences in training backgrounds, individual knowledge and opinions, and task interdependency necessitates skilled conflict management styles when addressing various clinical and professional scenarios. The goal of this study was to assess conflict styles in anesthesiology residents via self- and counterpart assessment during participation in simulated conflict scenarios.
Twenty-two first-year anesthesiology residents (first postgraduate year) participated in this study, which aimed to assess and summarize conflict management styles by 3 separate metrics. One metric was self-assessment with the Thomas-Kilmann Conflict Mode Instrument (TKI), summarized as percentile scores (0%-99%) for 5 conflict styles: collaborating, competing, accommodating, avoiding, and compromising. Participants also completed self- and counterpart ratings after interactions in a simulated conflict scenario using the Dutch Test for Conflict Handling (DUTCH), with scores ranging from 5 to 25 points for each of 5 conflict styles: yielding, compromising, forcing, problem solving, and avoiding. Higher TKI and DUTCH scores would indicate a higher preference for a given conflict style. Sign tests were used to compare self- and counterpart ratings on the DUTCH scores, and Spearman correlations were used to assess associations between TKI and DUTCH scores.
On the TKI, the anesthesiology residents had the highest median percentile scores (with first quartile [Q1] and third quartile [Q3]) in compromising (67th, Q1-Q3 = 27-87) and accommodating (69th, Q1-Q3 = 30-94) styles, and the lowest scores for competing (32nd, Q1-Q3 = 10-57). After each conflict scenario, residents and their counterparts on the DUTCH reported higher median scores for compromising (self: 16, Q1-Q3 = 14-16; counterpart: 16, Q1-Q3 = 15-16) and problem solving (self: 17, Q1-Q3 = 16-18; counterpart: 16, Q1-Q3 = 16-17), and lower scores for forcing (self: 13, Q1-Q3 = 10-15; counterpart: 13, Q1-Q3 = 13-15) and avoiding (self: 14, Q1-Q3 = 10-16; counterpart: 14.5, Q1-Q3 = 11-16). There were no significant differences (P > .05) between self- and counterpart ratings on the DUTCH. Overall, the correlations between TKI and DUTCH scores were not statistically significant (P > .05).
Findings from our study demonstrate that our cohort of first postgraduate year anesthesiology residents predominantly take a more cooperative and problem-solving approach to handling conflict. By understanding one's dominant conflict management style through this type of analysis and appreciating the value of other styles, one may become better equipped to manage different conflicts as needed depending on the situations.
成功解决冲突对于高效的团队合作至关重要，对于手术室中安全的患者护理也至关重要。在处理各种临床和专业场景时，能够理解培训背景、个人知识和意见以及任务相互依赖方面的差异，需要熟练的冲突管理风格。本研究的目的是通过参与模拟冲突场景时的自我评估和同行评估来评估麻醉学住院医师的冲突风格。
22 名一年级麻醉学住院医师（第一研究生年）参与了这项研究，旨在通过 3 种单独的指标来评估和总结冲突管理风格。一种指标是使用托马斯-基尔曼冲突模式工具（TKI）进行自我评估，总结为 5 种冲突风格的百分位分数（0%-99%）：协作、竞争、包容、回避和妥协。参与者还在模拟冲突场景中使用荷兰冲突处理测试（DUTCH）进行自我和同行评分，每个冲突风格的评分范围为 5 到 25 分：屈服、妥协、强迫、解决问题和回避。更高的 TKI 和 DUTCH 分数表示对给定冲突风格的更高偏好。符号检验用于比较 DUTCH 评分的自我和同行评分，Spearman 相关性用于评估 TKI 和 DUTCH 评分之间的关联。
在 TKI 上，麻醉学住院医师在妥协（中位数，四分位距 [Q1-Q3] = 27-87）和包容（中位数，Q1-Q3 = 30-94）风格中具有最高的中位数百分位分数，而在竞争（中位数，Q1-Q3 = 10-57）中得分最低。在每个冲突场景之后，居民及其在 DUTCH 上的同行报告了更高的中位数妥协（自我：16，Q1-Q3 = 14-16；同行：16，Q1-Q3 = 15-16）和解决问题（自我：17，Q1-Q3 = 16-18；同行：16，Q1-Q3 = 16-17），以及较低的强迫（自我：13，Q1-Q3 = 10-15；同行：13，Q1-Q3 = 13-15）和回避（自我：14，Q1-Q3 = 10-16；同行：14.5，Q1-Q3 = 11-16）评分。自我和同行在 DUTCH 上的评分之间没有显著差异（P>.05）。总体而言，TKI 和 DUTCH 评分之间的相关性没有统计学意义（P>.05）。
我们的研究结果表明，我们的一年级麻醉学住院医师群体主要采用更合作和以解决问题为导向的方法来处理冲突。通过这种类型的分析了解自己的主导冲突管理风格，并欣赏其他风格的价值，人们可能会更好地根据情况需要管理不同的冲突。
