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Teaching Conflict Resolutionon the Road to Milestone Attainment:
Lessons From Business, Diplomacy, And Theatre
Adam D. Wolfe, MD, PhD
Associate Program Director, BCM-CHofSA
Kim B. Hoang, MD
Chief Resident, BCM-CHofSA
Sarah F. Denniston, MD, FAAP
Associate Program Director, BCM-CHofSA
Association of Pediatric Program Directors
April 6, 2017
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Disclosures
• We have no relevant financial relationships with themanufacturers of any commercial products and/orproviders of commercial services discussed in thisworkshop.
• We do not intend to discuss an unapproved/investigative use of a commercial product/device inour presentation.
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Objectives
1. Identify sources of conflict that may impactresident or fellow performance and preventmaximal milestone progression alongcommunication and professionalismsubcompetencies
2. Discuss team dynamics that can lead to conflict
3. Employ a structured approach to teach conflictresolution to learners that emphasizesprofessionalism and relationships
4. Demonstrate exercises to improve traineeawareness of nonverbal cues in communication
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Agenda
• Team dynamics
• Conflict resolution hierarchy
• Themes that underlie conflict
• Conflict resolution styles
• Nonverbal communication
• Discussion & evaluation
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Subcompetencies and Milestones
• Milestone content relevant to communication
• ICS1, ICS2
• PBLI4
• PROF1, PROF2, PROF3
• SBP1, SBP2
Bogetz et al., 2017
Look here forrelevant
subcompetencies
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Small groups: Conflict in Continuity Clinic
• 1 mo girl presents for propagating right periorbital hemangioma
• PGY-2 resident reviews evidence, plans to start propranolol
• Attending has not done this before, knows the lesion is likely to regress
• Resident presents literature, suggests treatment vs. referral
• Attending describes discomfort using propranolol in infants, does notwant to treat or refer
• Resident feels lesion will propagate in a way that could threaten vision
• Resident reports concern to hospital ethics committee
• Attending notifies Program Director that this resident is no longerwelcome in this clinic
• You are the Residency Executive Committee:
• Come to consensus on how to respond
• Consensus = every group member agrees withthe entire response
• Write down your responseSBP3, PBLI4,
PROF2, PROF3,ICS2
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Debrief & Reflection
• How did your group start the discussion?
• Was there an effort made to define the problem?
• What roles did different group members play?
• What difficulties did you encounter during the discussion?
• Did you identify a process for reaching agreement?
PBLI4, PROF1,PROF2
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Team dynamics &Conflict resolution hierarchy
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Phases of team development
• High motivation• Low performance• Flesh out goals• Identify roles• Develop
processes• Develop
relationships
• Members collideor disagree
• Conflicts impedeperformance
• Responsibilitiesaccepted
• Workaccomplished
• Relationshipssolid
• Goals clear• Roles clear• Processes clear
• Trust• Cooperation• Peak performance
Tuckman, 1965; Raue et al. (2013): Systemic Excellence Group.SBP1, SBP3
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• Direction is clear
• Values are shared
• Purpose is shared
• Responsibilities are defined
• Everyone understands each other’s role
• Communication is clear
• Decision making authority is established
• Rules exist for resolution of disputes
• Trust is established
• Members support each other
• Interactions are friendly
GRPI: Teamwork & conflictresolution hierarchy
modified from Beckhard R. J Contemporary Business 1972:23–27.SBP1, SBP3,PROF2, ICS2
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Using GRPI to identifysource of conflict
Tichy, 2002; Raue et al., 2013.
SBP1, SBP3,PROF2, ICS2
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Small groups
Identify at least 1 example of conflict in medicine or medicaleducation for each category:
• Goals disagreement
• Roles disagreement
• Process disagreement
• Interpersonal interactions
SBP1, SBP3,ICS2
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Conflict resolution styles
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Conflict resolution stylesC
ON
CER
NFO
RSU
BST
AN
CE
/A
SSER
TIV
ENES
S
Low
Mo
de
rate
Hig
h
Low Moderate HighCONCERN FOR RELATIONSHIP / COOPERATION
Compete(Defeat)
Be a winner atany cost
Withdraw(Avoid)
Take whateveryou can get
Collaborate
Problem solvecreatively so
everyone wins
Accommodate(Give in)
Build friendlyrelationships
Compromise
Split thedifference
modified from Thomas KW, Kilmann RH (1974). Tuxedo, NY: XICOM, Inc.
SBP1,SBP3,PBLI4
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Where do you fall?
• Conflict instruments
(based off of Thomas-Kilmann)
• In the starting exercise?
• In collegial relationships?
• In personal relationships?
• In patient/family relationships?
Defeat
Be a winner at anycost
Withdraw
Take whatever youcan get
Accommodate
Build friendlyrelationships
Compromise
Split the difference
Collaborate
Problem solvecreatively so
everyone wins
SBP1, SBP3,PBLI4, ICS1,
ICS2
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Small groups: Inpatient Chain of Command
• 0600: Handoff - 8 yo boy with short gut, TPN-dependent, admitted forfever, overnight resident signs out patient looks great & likely discharge
• 0620: Intern pre-rounds on patient, febrile to 101, patient sleeping,examined in the dark but looks well other than fever
• 0625: Intern proceeds to other 7 patients to pre-round
• 0630: RN calls intern concerned, patient is tachypneic, intern tells RNthat she just saw the patient and he looks fine
• 0729: Code Blue called, patient hypotensive, respiratory distress, shock
• Later in ICU: Patient stable s/p 3 boluses, 2 pressors, intubation, bloodculture from central line grows GNR at 6 hours
• Post hoc: Residents unaware of CVC, attending not notified prior to Code,original RN files event report
• You are the Peer Review Committee:
• Come to consensus on how to respond
• Consensus = every group member agrees with the entire response
• Write down your response
SBP3, PBLI4,PROF2,
PROF3, ICS2
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Debrief & Reflection
• Was this scenario easier orharder than the first one?
• Did you try to employ astrategy (e.g., GRPI) foraddressing disagreement?
• Was it helpful?
• What problems arose duringthis scenario?
• Which conflict resolutionstyles did youexhibit/observe?
PBLI4, PROF1,PROF2
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Nonverbal communication
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The things we don’t say
Ways of talking(e.g., pauses,
stress on words)
Posture(e.g., slouching)
Appearance(e.g., tidiness)
Headmovements
(e.g., nodding)
Handmovements
(e.g., waving)Closeness
(e.g., nearness,invading space)
Body contact(e.g., shaking
hands, hugging)
Facial expression(e.g., smile, frown)
Eye movements(e.g., winking)
Sounds(e.g., laughing)
NON-VERBALCOMMUNICATION
PROF3, ICS2
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Nonverbal communication:What are they saying?
www.bodylanguagesuccess.com
2009
Pres. Vladimir Putin(Russia)
Pres. Barack Obama(US)
PROF3, ICS2
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Nonverbal cues exercise
• We’re going to count to 20
• Rules
• You may not speak except to say numbers
• You must say the next number in sequence
• Start over at 1 if:
• More than one person speaks at once
• One person says two consecutive numbers
• Any non-number words are spoken
• A number is repeated or skipped
ICS2
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That was easy
• If you use this exercise with learners:
• Now close your eyes and try it again
ICS2
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Personal reflection:Have trainees try this at home
• What personal frustrations did you experience during arecent conflict or disagreement?
• Was there an argument?
• Did you employ a strategy (e.g., GRPI) to attempt to resolvethe disagreement?
• To what extent did you:
• Represent your beliefs?
• Make compromises?
• Get angry?
• Listen to others?
PBLI4, PROF1,PROF2, ICS2
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Handouts:
• All of the topics/tools wediscussed today
• Pocket card: GRPI and styles
• Additional scenarios and toolsfor teaching conflictresolution
• 8 pediatric subcompetencieswith milestones highlighted
Contact us!
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