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Introduction: Patient handoffs from emergency physicians (EP) to internal medicine (IM) physicians may be complicated by conflict with the potential for adverse outcomes. The objective of this study was to identify the specific types of, and contributors to, conflict between EPs and IM physicians in this context. Methods: We performed a qualitative focus group study using a constructivist grounded theory approach involving emergency medicine (EM) and IM residents and faculty at a large academic medical center. Focus groups assessed perspectives and experiences of EP/IM physician interactions related to patient handoffs. We interpreted data with the matrix analytic method. Results: From May to December 2019, 24 residents (IM = 11, EM = 13) and 11 faculty (IM = 6, EM = 5) from the two departments participated in eight focus groups and two interviews. Two key themes emerged: 1) disagreements about disposition (ie, whether a patient needed to be admitted, should go to an intensive care unit, or required additional testing before transfer to the floor); and 2) contextual factors (ie, the request to discuss an admission being a primer for conflict; lack of knowledge of the other person and their workflow; high clinical workload and volume; and different interdepartmental perspectives on the benefits of a rapid emergency department workflow). Conclusions: Causes of conflict at patient handover between EPs and IM physicians are related primarily to disposition concerns and contextual factors. Using theoretical models of task, process, and relationship conflict, we suggest recommendations to improve the EM/IM interaction to potentially reduce conflict and advance patient care.

Abstract Introduction The medical education literature shows that residents spend at least 25% of their time teaching, enjoy teaching, consider it important, and agree that teaching improves their clinical knowledge and clinical skills. However, in today's busy training environments, there is limited time to formally train residents as teachers. Methods We developed a multidisciplinary, resident-as-teacher curriculum that includes a DVD series and accompanying self-study and facilitator guides to help program directors, medical educators, and residents take the first step in implementing cross-departmental teacher training. The entire curriculum was presented to all Beth Israel Deaconess Medical Center (BIDMC) residency program directors and at the Harvard Medical School's Resident-as-Teacher Curriculum Showcase. To date, the departments of medicine, obstetrics and gynecology, surgery, emergency medicine, dermatology, anesthesiology, neurology, and radiology have used the facilitator's guide to lead small-group resident-as-teacher sessions or have engaged their residents in self-study using the guide and videos. The DVD series may be used as part of a resident self-study program, as the basis of a facilitator-led teaching series for house staff, or as preparatory material for “flipped” classroom-type sessions. Results Eleven senior residents, from across departments, and three junior faculty members piloted and assessed the quality of the series. All found the series to be “Quite” or “Extremely Useful” in terms of introducing the skills of clinical teaching and all found the overall quality of the series to be “Excellent.” We also conducted an assessment of the effectiveness of presenting the series in AY2014 and 2015 as part of a “Fourth-Year Boot Camp” to senior Harvard Medical students (n = 22) who were about to start surgical or obstetrics and gynecology residencies. Pre− and post-evaluation of the large-group sessions using the DVD modules, PowerPoint, pocket guide, and facilitator's guide showed that the students perceived significant improvements in several areas in terms of their teaching comfort and confidence. Discussion We are currently conducting a multidisciplinary, clinical teaching observation study to determine the extent to which the series and accompanying guide have an impact on the residents' clinical teaching skills, regardless of department. Preliminary data from this study indicate that during the post-intervention observation, residents are more likely to ask students about their learning goals, encourage more student questions, inquire about the student's perspective on a case, encourage self-directed learning, and provide specific learner feedback.