Birnbach David J, Rosen Lisa F, Fitzpatrick Maureen, Shekhter Ilya, Arheart Kristopher L
From the Department of Anesthesiology, University of Miami Miller School of Medicine, UM-JMH Center for Patient Safety, Miami, Florida.
University of Miami Miller School of Medicine, UM-JMH Center for Patient Safety, Miami, Florida.
Anesth Analg. 2021 Dec 1;133(6):1617-1623. doi: 10.1213/ANE.0000000000005561.
The hierarchical culture in high-stake areas such as operating rooms (ORs) may create volatile communication challenges. This unfunded exploratory study sought to establish whether a conflict resolution course was effective in preparing anesthesiology residents to handle and deescalate disagreements that may arise in the clinical environment, especially when challenging a surgeon.
Thirty-seven anesthesiology residents were assessed for ability to deescalate conflict. Nineteen had completed a conflict resolution course, and 18 had not. The 2-hour course used 10 videotaped vignettes that showed attending anesthesiologists, patients, and surgeons challenging residents in a potentially confrontational situation. Guided review of the videos and discussions was focused on how the resident could optimally engage in conflict resolution. To determine efficacy of the conflict resolution course, we used simulation-based testing. The setting was a simulated OR with loud music playing (75-80 dB) under the control of the surgeon. The music was used as a tool to create a potential, realistic confrontation with the surgeon to test conflict resolution skills. The initial evaluation of the resident was whether they ignored the music, asked for the surgeon to turn it off, or attempted to turn it off themselves. The second evaluation was whether the resident attempted to deescalate (eg, calmly negotiate for the music to be turned off or down) when the surgeon was scripted to adamantly refuse. Two trained observers evaluated residents' responses to the surgeon's refusal.
Of the residents who experienced the confrontational situation and had not yet taken the conflict resolution course, 1 of 5 (20.0%; 95% CI, 0.5-71.6) were judged to have deescalated the situation. In comparison, of those who had taken the course, 14 of 15 (93.3%; 95% CI, 68.1-99.8) were judged to have deescalated the situation (P = .002). Only 2 of 19 (10.5%; 95% CI, 1.3-33.1) of those who completed the course ignored the music on entering the OR versus 10 of 18 (55.6%; 95% CI, 30.8-78.5) who did not complete the course (P = .004).
This study suggests that a conflict resolution course may improve the ability of anesthesiology residents to defuse clinical conflicts. It also demonstrated the effectiveness of a novel, simulation-based assessment of communication skills used to defuse OR confrontation.
手术室等高风险领域的层级文化可能带来多变的沟通挑战。这项自筹经费的探索性研究旨在确定冲突解决课程是否能有效帮助麻醉科住院医师应对并缓和临床环境中可能出现的分歧，尤其是在挑战外科医生时。
对37名麻醉科住院医师的冲突缓和能力进行评估。其中19人完成了冲突解决课程，18人未完成。这门时长两小时的课程使用了10个录像短剧，展示了主治麻醉师、患者和外科医生在可能引发冲突的情境中为难住院医师的场景。对视频的引导性回顾和讨论聚焦于住院医师如何能最佳地参与冲突解决。为确定冲突解决课程的效果，我们采用了基于模拟的测试。测试场景是一个模拟手术室，在外科医生的控制下播放着吵闹的音乐（75 - 80分贝）。音乐被用作一种工具，与外科医生制造一场潜在的、现实的冲突，以测试冲突解决技能。对住院医师的初次评估是他们是否忽略音乐、要求外科医生关掉音乐，或者自己试图关掉音乐。第二次评估是当按照脚本设定外科医生坚决拒绝时，住院医师是否试图缓和冲突（例如，平静地协商把音乐关掉或调小）。两名经过培训的观察者评估住院医师对外科医生拒绝的反应。
在经历了冲突情境且尚未参加冲突解决课程的住院医师中，5人中有1人（20.0%；95%置信区间，0.5 - 71.6）被判定缓和了局势。相比之下，参加了课程的住院医师中，15人中有14人（93.3%；95%置信区间，68.1 - 99.8）被判定缓和了局势（P = .002）。完成课程的19人中只有2人（10.5%；95%置信区间，1.3 - 33.1）在进入手术室时忽略音乐，而未完成课程的18人中有10人（55.6%；95%置信区间，30.8 - 78.5）忽略音乐（P = .004）。
本研究表明，冲突解决课程可能会提高麻醉科住院医师化解临床冲突的能力。它还证明了一种新颖的、基于模拟的沟通技能评估方法在化解手术室冲突方面的有效性。
