Residents Lack Conflict Management Skills, Raising Ethical Concerns
March 1, 2025 3 minutes read
By Stacey Kusterbeck
As an intern, Chinedu Okoli, MBBS, witnessed a conflict between two senior residents during a weekend call shift. “The program director was involved, and I wasn’t sure if the two residents ever resolved this personal conflict,” says Okoli, currently a resident at Maine Medical Center. The incident led Okoli to design a longitudinal study to learn more about the conflicts residents encounter and how those conflicts are addressed. Okoli and colleagues surveyed 65 resident physicians and interviewed 15 resident physicians. Residents’ conflict competence was low and did not reflect the complexity of their work environments.1
More than half (53.8%) of residents reported experiencing or witnessing conflicts weekly. Most of the conflicts were between resident physicians and nurses, and most went unresolved. About one-quarter of the conflicts were caused by communication failures. “Conflicts vary from procedure-based to personality-based, including conflicts arising from limited resources and resource management,” says Okoli.
Most residents (87.3%) reported that the conflicts affected the quality of care patients received. A lesser number (12.3%) indicated that conflicts led to patient safety concerns. One resident reported that a conflict had a severe adverse effect on a patient.
“If residents avoid conflict, as this study indicates, instead of resolving it, could patients potentially be harmed as a result?” asks Okoli. “Every aspect of patient care is affected by these conflicts, including quality and, at times, safety of the patient.”
Residents with previous training in conflict competence were more likely to resolve conflicts they experienced. However, more than half of the respondents were unfamiliar with any style of conflict resolution. Most residents stated that they used avoidance to address conflict. “Lack of conflict management has the potential of causing favoritism, biased decision-making, and undermining the integrity of the healthcare team,” concludes Okoli.
Three-quarters of residents had no prior training in conflict management. Most (83.1%) residents expressed an interest in conflict competence training. “Conflict management training, in my opinion, should be part of residents’ onboarding process,” says Okoli. “We are currently working on a study to develop conflict training for residents.”
Unresolved conflicts between clinicians, patients, and family members can lead to breakdowns in communication, erosion of trust, and suboptimal care. “Ethical concerns arise when conflicts hinder shared decision-making, or compromise the therapeutic relationship,” says Chelsey Patten, DBe, HEC-C, director for clinical ethics at the Center for Bioethics and Humanities at University of Colorado Anschutz Medical Campus. For patients, this can delay or hinder care and lead to feelings of being dismissed or misunderstood. “For healthcare providers, persistent conflicts — especially when they involve values-based disagreements — can contribute to burnout, moral distress, and a sense of professional isolation,” says Patten.
Differing interpretations of what is in the patient’s best interest can escalate into conflicts. “These situations often lead to ethics consultations that might have been avoidable with better training in conflict management and foundational ethics,” says Patten.
Teaching conflict resolution without ethical principles leaves physicians ill-equipped to address values-based disagreements, argues Patten. Similarly, ethics training without conflict management skills leaves clinicians unable to apply knowledge effectively in real-world scenarios. “Ethicists are well-positioned to help address these gaps,” says Patten. Patten suggests these approaches:
- Proactively: Ethics teams can provide workshops that combine conflict resolution strategies with foundational ethics education. For example, ethicists can teach clinicians to navigate disagreements about end-of-life care or cultural values. This bridges the gap between theoretical knowledge and practical application. “This allows clinicians to reflect on challenging cases and build ethical reasoning and communication skills in a supportive environment,” Patten explains.
- During consultations: Ethicists can model how to address values-based dilemmas while managing conflict. “Ethicists can demonstrate the practical interplay between ethical reasoning and conflict resolution. Observing these strategies in action can be an invaluable learning experience for clinicians,” says Patten.
- Systemwide: Ethicists can collaborate with leadership and professional development teams to create interdisciplinary training programs. “Such programs can integrate ethics and conflict resolution into broader institutional education initiatives,” says Patten.
Reference
1. Okoli C, Olsen B, Falank C, et al. Conflict competence among resident physicians: Knowledge and perception. J Surg Educ. 2024;81(12):103310.
Chinedu Okoli, MBBS, and colleagues surveyed 65 resident physicians and interviewed 15 resident physicians to learn more about the conflicts residents encounter and how those conflicts are addressed.
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