Conflict resolution curriculum in capstone
cooperativeness
Duke University School of Medicine has a mandatory, longitudinal transition to residency course for fourth-year medical students. Individual students are assigned faculty coaches (1 faculty: 8 students) at the start of the course. Coaches provide individual feedback to students across several exercises, such as a discharge summary, informed consent, managing difficult conversations, handoffs, simulated paging, triage, and high-fidelity simulation. In 2017, conflict resolution was added to this curriculum. A full description of the conflict resolution curriculum, including students pre-work, description of the simulation and training of actors, post-work and assessment rubric has been previously published [After simulation, the student and the student’s coach review the student’s video and assess the student’s conflict resolution skills using a previously described rubric [The negotiation score was developed by finding overlap from conflict resolution skills in the list of entrustable behaviors for teamwork published by the American Association of Medical Colleges [Generalizable communication skills were defined in concert with clinical skills director and included skills students had been assessed on in prior standardized patient encounters including: (1) ability to listen, (2) ability to acknowledge concerns, (3) ability to ask questions effectively, (4) appropriate body language, (5) emotional intelligence, and (6) patient-centered conversation. The maximum amount of points for this section, called the emotional quotient score, was the sum of scores from six 100-point assessments for a total of 600.Entrustability was determined based on the Association of American Medical Colleges (AAMC)’s Core Entrustable Professional Activities (EPA) for Entering Residency #9: Collaborate as a member of an interprofessional team [To evaluate if awareness of conflict resolution style effected conflict resolution performance, we randomized the groups of students to taking the Thomas-Kilmann Instrument (TKI) before the simulation or after the simulation; these will henceforth be referred to as the “before” and “after” groups, respectively. The TKI is a validated and widely used tool to describe and study behavior in conflict scenarios [
The five-conflict resolution styles as described by the TKI on scales of assertiveness and cooperativeness. Figure adapted from TKI [Student groups were randomized by flip of coin to the “before” or “after” group. Randomization occurred in groups to facilitate timing of simulation with standardized patients. Groups randomized to the completing the TKI after their session needed longer time in the simulation space, thus impacting scheduling of students in that space. While the clinical skills lab director was aware of randomization for the purpose of scheduling students, this randomization did not affect the duration of time for the SP encounter. SP and faculty coaches were blinded to the students’ groups. See Fig. 
Students were randomized into before and after groups. In the before group, the TKI was taken prior to the SP encounter. In the after group, the TKI was taken after the SP encounter, but prior to the self-evaluationStudents rated the value of the exercise in their postwork using 5-point Likert-scale (from not useful = 0 to extremely useful = 5) Students were asked specifically on the usefulness of the exercise in regards to (1) having information from the TKI prior to the SP encounter, (2) learning the background to conflict resolution, (3) reviewing the pre-work videos, and (4) self-assessing their own performance in conflict resolution by viewing a video of their encounter.The potential impact potential impact of gender, under-represented minority status, and intended specialty on faculty determinations of entrustability were assessed after course completion and after final grades for the pass/fail course were issued.