Communication with other professionals and conflict
Stem
You are the anesthesiologist for Mr. Alvarez, a 71-year-old man, 88 kg, scheduled for an elective laparoscopic right hemicolectomy for colon cancer as the first case. His troponin drawn this morning is newly elevated, and he tells you he had two episodes of chest tightness this week. The colorectal surgeon has come to the preoperative area to find out why the case has not started. Your task: present your recommendation to the surgeon. The patient is not in the room.
Question
I hear you're holding up my nine o'clock. We're already behind and I have three more cases, so what's the problem?
Ideal answer
Headline"I have a safety concern: his troponin this morning is newly elevated, with chest tightness twice this week. I recommend we hold the case and get cardiology to see him this morning."
- Clear, professional, the key fact first. "I'm Dr. Reyes, the anesthesiologist for Mr. Alvarez. I'm worried he's having an active heart problem right now, and a general anesthetic plus a big abdominal operation today puts him at real risk of a heart attack on the table."
- Listen actively. "Before we decide anything, I want to hear your side. What worries you most about waiting?"
- Reflect and find the shared goal. "So your concern is that this slot won't come back for three weeks, and you don't want his cancer to wait that long. That's fair, and we both want him through this operation safely."
- Resolve with options. "I call cardiology now. If they see him within the hour and find this isn't his heart, we do him later today. If not, you and I go to scheduling together for the first slot after he's optimized."
- Close the loop. "So I call cardiology, you tell the OR desk we may slide, and we talk again at ten. Does that work for you?"
Breaking down the answer
- How I communicate, not whether I am right — four behaviors: clear and professional, patient-relevant information first, active listening, recognizing potential conflict and initiating resolution.1 ABA sample: new atrial fibrillation at 130 before an elective facelift; postponement presented to the surgeon, no patient present.2
- Professional tone — introduction, role, purpose, calm, no sarcasm or blame, never criticizing the colleague personally or in front of the patient: a colleague who feels attacked stops listening, and then the patient loses.
- Prioritize — the fact that changes management first, background briefly after. SBAR (situation, background, assessment, recommendation) is the frame the grader recognizes; of five facts in the stem, only one or two belong in the first sentence.
- Why listening is scored — an open question, no interruptions; the reflective summary surfaces the real objection, which is often logistics, not medicine.
- Resolve conflict — name the disagreement openly, find the shared goal, offer options: same-day cardiology, a later slot today, a different anesthetic.1 Changes if: safety at stake and no agreement, I escalate through the chain of command, respectfully.
- Close the loop — who calls whom and by when; closed-loop communication prevents the "I thought you were doing it" failure.
Follow-up question
The surgeon raises his voice: "I've done this operation a thousand times. Your job is to put him to sleep, not to cancel my list." He turns to leave for the OR. How do you respond?
Follow-up answer
HeadlineA standoff over a safety issue; I do not match his volume or take the bait, and I acknowledge him first.
"I know you're under time pressure, and you know this operation better than anyone." Then graded language: "I'm concerned. I'm uncomfortable proceeding with a new troponin rise. This is a patient safety issue." The concrete path again: cardiology now, and if they rule out a cardiac cause within the hour, we still go today. If he refuses, I calmly say I will not start the anesthetic and am calling the department chief or medical director, because a safety disagreement needs a third view. I check back once cardiology answers, so the working relationship survives.
Pitfalls that cost points
- Opening with the conflict before stating the patient facts.
- Burying the critical fact in a long history.
- Interrupting or rehearsing my reply while the colleague speaks.
- Capitulating to pressure on a safety issue, or digging in on a preference that is not a safety issue.
Rapid-fire
Q: How do I start a hard conversation with a senior surgeon? A: Name, role, purpose and the single fact: "I have a safety concern about this patient: his potassium is 6.4."
Q: What if a resident made the error? A: Private setting, facts not judgment, ask what happened, focus on the patient and the system fix, and agree on disclosure and reporting.
Q: When do I escalate? A: When a safety concern stated twice is not addressed; the two-challenge rule and the chain of command exist for exactly this.
Q: How do I structure a handoff? A: A standard tool such as SBAR or I-PASS, the critical item first, and a read-back from the receiver.
Numbers to know
| Item | Value |
|---|---|
| Station time | 8 min, 4-min read, warning at 6 min3 |
| Professionals checklist behaviors | 41 |
| SBAR elements | 4: situation, background, assessment, recommendation |
| CUS escalation | 3 levels: concerned, uncomfortable, safety issue |
| Challenges before escalation | 2 |
Links
- OSCE day: stations, timing, who is in the room, Disclosing a peri-procedural complication or error, Practice-based learning and QI projects, Preoperative cardiac evaluation for non-cardiac surgery, Recent MI, coronary stents and antiplatelet therapy
- AHRQ TeamSTEPPS curriculum; ASA Statement on Professionalism
Sources
- 1.APPLIED Examination OSCE Content Outline · ABA · theaba.org
- 2.OSCE Example Scenarios · ABA, 2023 · theaba.org
- 3.What to Expect for Your APPLIED Exam (APPLIED Exam Manual) · ABA, 2026 · theaba.orgRevised July 2026.
Facts on this page were checked against these sources on Oct 14, 2026. Guidelines change; confirm doses against current institutional protocols.