Published online May 14, 2017. doi: 10.3748/wjg.v23.i18.3315
Peer-review started: December 29, 2017
First decision: February 10, 2017
Revised: March 4, 2017
Accepted: April 21, 2017
Article in press: April 21, 2017
Published online: May 14, 2017
Processing time: 138 Days and 1.5 Hours
To assess first-year gastroenterology fellows’ ability to address difficult interpersonal situations in the workplace using objective structured clinical examinations (OSCE).
Two OSCEs (“distracted care team” and “frazzled intern”) were created to assess response to disruptive behavior. In case 1, a fellow used a colonoscopy simulator while interacting with a standardized patient (SP), nurse, and attending physician all played by actors. The nurse and attending were instructed to display specific disruptive behavior and disregard the fellow unless requested to stop the disruptive behavior and focus on the patient and procedure. In case 2, the fellow was to calm an intern managing a patient with massive gastrointestinal bleeding. The objective in both scenarios was to assess the fellows’ ability to perform their duties while managing the disruptive behavior displayed by the actor. The SPs used checklists to rate fellows’ performances. The fellows completed a self-assessment survey.
Twelve fellows from four gastrointestinal fellowship training programs participated in the OSCE. In the “distracted care team” case, one-third of the fellows interrupted the conflict and refocused attention to the patient. Half of the fellows were able to display professionalism despite the heated discussion nearby. Fellows scored lowest in the interprofessionalism portion of post-OSCE surveys, measuring their ability to handle the conflict. In the “frazzled intern” case, 68% of fellows were able to establish a calm and professional relationship with the SP. Despite this success, only half of the fellows were successfully communicate a plan to the SP and only a third scored “well done” in a domain that focused on allowing the intern to think through the case with the fellow’s guidance.
Fellows must receive training on how to approach disruptive behavior. OSCEs are a tool that can assess fellow skills and set a culture for open discussion.
Core tip: Disruptive behavior in the hospital setting is associated with adverse events. Fellows must be able to effectively communicate with attending physicians and ancillary staff when there is a difficult situation to prevent such occurrences. Our study seeks to assess gastroenterology fellows’ ability to address such behavior in the workplace using an objective structured clinical examination. We found that fellows had difficulty navigating the situations and inconsistently mediated conflicts between others. Using this pilot data, we believe it is important that fellows receive training to handle disruptive behavior so as to set an expectation and a culture of open communication.