Beyond fight or flight: The need for conflict management training in medical education

• Date: 01 May 2018
• Author: Peter Thurber,Nan Cochran,Elliott Fisher,Paul Charlton,Virginia Reed
• Published date: 01 May 2018
• DOI: http://doi.org/10.1002/crq.21218

RESEARCH ARTICLE

Beyond fight or flight: The need for conflict

management training in medical education

Nan Cochran

1,2

| Paul Charlton

3

| Virginia Reed

4

| Peter Thurber

2

|

Elliott Fisher

1,2,4

1

Department of Medicine, Geisel School of

Medicine at Dartmouth, Hanover, New Hampshire

2

The Dartmouth Institute for Health Policy and

Clinical Practice, Lebanon, New Hampshire

3

Department of Emergency Medicine, University

of Washington, Seattle, Washington

4

Department of Community and Family Medicine,

Geisel School of Medicine at Dartmouth,

Hanover, New Hampshire

Correspondence

Paul Charlton, Department of Emergency

Medicine, University of Washington, 325 Ninth

Avenue, Box 359702, Seattle, WA 98104.

Email: pwc9@uw.edu

This article reviewed the literature on conflict manage-

ment training in medicine, proposed a set of competen-

cies that health professionals need to learn in order to

effectively deal with conflict in health care settings, and

described a pilot project designed to teach many of these

competencies at Dartmouth. Our review of the evidence,

discussions with experts, and pilot findings highlight the

potential value of incorporating comprehensive conflict

management training in medical education. Further

research is needed to evaluate the optimal timing and

most effective ways to teach these skills in medical

school, residency, and beyond.

1|INTRODUCTION

Conflict is widespread and manifests in multiple ways in health care settings. From managing a com-

plex patient while working with family members and specialists who have divergent points of view,

to learning to work in newly established interdisciplinary teams, to implementing evidence-based

guidelines on a system level, to negotiating the merger of a hospital, the health care field exposes phy-

sicians, nurses, and health care administrators to conflict on a daily basis (Anderson & D'Antonio,

2005). Evidence is emerging that poorly managed conflict in health care causes serious adverse conse-

quences (The Joint Commission, 2008). Poor communication has been identified as one of the major

causes of medical errors (Leonard, Graham, & Bonacum, 2004; Rosenstein & O'Daniel, 2008). Inef-

fective teamwork, often in the context of unprofessional behavior, negatively impacts patient care

(Riskin et al., 2017) and contributes to physician, student, and staff burnout (Spence Laschinger,

Leiter, Day, & Gilin, 2009). Health care reform increases the need for effective conflict management

skills because of the transition to team-based care models, such as Patient-Centered Medical Homes,

and the emergence of new organizational forms that require collaboration across traditional organizational

boundaries, such as Accountable Care Organizations (Kohn, Corrigan, & Donaldson, 2000).

It is no surprise, therefore, that major health care and nongovernmental organizations are calling

for increased training in communication, negotiation, and conflict management skills. In this article,

Received: 15 October 2017 Revised: 2 March 2018 Accepted: 6 March 2018

DOI: 10.1002/crq.21218

© 2018 Association for Conflict Resolution and Wiley Periodicals, Inc.

Conflict Resolution Quarterly. 2018;35:393–402. wileyonlinelibrary.com/journal/crq 393