Communication with other professionals and conflict
Why examiners ask this
Most perioperative harm traces back to a conversation that did not happen or went badly: a handoff missing the key fact, a surgeon who pushed ahead, a nurse who saw something and did not say it. This station puts me across from a colleague, played by an actor, with a conflict built in: a surgeon who wants to proceed with an unoptimized patient, a resident who made an error, a PACU nurse who disagrees with my plan. The ABA sample is exactly this: new-onset atrial fibrillation at 130 found before an elective facelift, and the task is to present my recommendation to postpone to the surgeon, with no patient in the room.1 The grader scores four behaviors, and every one of them is about how I communicate, not whether I am right.2
The 60-second answer
I read the stem for the colleague, the patient issue and the conflict. I introduce myself and my role and state the purpose: "I want to talk about Mr. Alvarez before we start; I have a safety concern." I give the patient-relevant facts first, structured as situation, background, assessment and recommendation, and I keep them short. Then I stop and listen. I ask the colleague's view and reflect it back so they know I heard it. Where we disagree I name the shared goal, the patient's safety, and separate positions from interests: the surgeon wants the case done today; I want the patient not to have a cardiac event. I propose an option that serves both. If we cannot agree on a matter of safety, I say plainly what I will do and who I will involve. I close by confirming the plan and who does what.
Decision points and the "why"
- Communicate clearly and professionally — introduction, role, purpose, calm tone, no sarcasm or blame. It is scored because a colleague who feels attacked stops listening, and then the patient loses.
- Prioritize patient-relevant information — I lead with the fact that changes management: "His troponin this morning is newly elevated." Background comes after, briefly. SBAR is the frame the grader recognizes.
- Listen actively — open questions, no interruptions, and a reflective summary: "So the concern is that the OR slot won't come back for three weeks." Active listening is scored because it surfaces the real objection, which is often logistics, not medicine.
- Recognize and resolve conflict — the outline wording is to recognize the potential for conflict and initiate conflict resolution.2 I name the disagreement openly rather than talking around it, find the shared goal, and offer options: a same-day cardiology consult, a later slot today, a different anesthetic. If safety is at stake and agreement fails, I escalate through the chain of command and say so respectfully.
- Close the loop — I restate the agreed plan, who calls whom and by when. Closed-loop communication prevents the "I thought you were doing it" failure.
The complication they will inject
The surgeon raises his voice: "I've done this operation a thousand times. Your job is to put him to sleep." I do not match the volume and I do not take the bait. I acknowledge his experience and pressure: "I know you're under time pressure and you know this operation well." Then I restate the specific concern using clear, graded language: "I'm concerned. I'm uncomfortable proceeding with a new troponin rise. This is a patient safety issue." I propose a concrete path: "Let me call cardiology now; if they see him within the hour we can still go today." If he refuses, I tell him calmly that I will not start the anesthetic and that I am involving the department chief or medical director, because a disagreement over safety needs a third view. The scored behavior is holding a safety line without damaging the relationship.
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.
- Criticizing the colleague personally or in front of the patient.
Rapid-why
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 | 42 |
| 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.OSCE Example Scenarios · ABA, 2023 · theaba.org
- 2.APPLIED Examination OSCE Content Outline · ABA · 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.