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©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
Disruptive behavior in the workplace: Challenges for gastroenterology fellows
Nalinee Srisarajivakul, Catherine Lucero, Xiao-Jing Wang, Michael Poles, Colleen Gillespie, Sondra Zabar, Elizabeth Weinshel, Lisa Malter
Nalinee Srisarajivakul, Michael Poles, Colleen Gillespie, Sondra Zabar, Elizabeth Weinshel, Lisa Malter, Division of Gastroenterology, VA New York Harbor Healthcare System, New York, NY 10010, United States
Nalinee Srisarajivakul, Michael Poles, Colleen Gillespie, Sondra Zabar, Elizabeth Weinshel, Lisa Malter, Division of General Internal Medicine, NYU School of Medicine, New York, NY 10016, United States
Catherine Lucero, Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY 10021, United States
Xiao-Jing Wang, Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA 30322, United States
Author contributions: Srisarajivakul N, Lucero C, Weinshel E and Malter L contributed to analysis and interpretation of the data; Srisarajivakul N, Lucero C, Poles M, Weinshel E and Malter L contributed to drafting of the manuscript; Lucero C, Wang XJ, Weinshel E and Malter L contributed to study concept and design; Lucero C, Wang XJ, Gillespie C, Weinshel E and Malter L contributed to data acquisition; Wang XJ, Poles M, Gillespie C and Zabar S contributed in critical revision of the manuscript for important intellectual content; Malter L supervised the study.
Institutional review board statement: This work was considered a performance improvement project and approval was not indicated by the NYU School of Medicine Institutional Review Board.
Informed consent statement: Informed written consent was not obtained from gastroenterology fellows who participated voluntarily in this study. The participants were anonymized when compared to the group as a whole. Results of the individual fellows’ performances were provided to their program directors for report card purposes.
Conflict-of-interest statement: None of the authors have declared any conflict of interest.
Data sharing statement: Not applicable
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Elizabeth Weinshel, MD, Professor, Division of Gastroenterology, VA New York Harbor Healthcare System, 423 East 23rd Street, New York, NY 10010, United States.
elizabeth.weinshel@nyumc.org
Telephone: +1-917-6347394 Fax: +1-917-6347394
Received: December 28, 2017
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
AIM
To assess first-year gastroenterology fellows’ ability to address difficult interpersonal situations in the workplace using objective structured clinical examinations (OSCE).
METHODS
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.
RESULTS
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.
CONCLUSION
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.
