New:
"The Transition to
Doctor of Physical Therapy"

Presented by:
Marjane Selleck, PT, MS, PCS

Conflict Resolution Frequently Asked Questions (FAQ)

Conflicts arise in clinical education. They can involve the academic program, the site administration, the clinical instructor, the student, support staff, patient, and/or family members of the patient. With so many players wearing different ‘lenses’ it is a challenge to negotiate meaningful resolutions that satisfy all participants. The FAQ provided here are intended to prompt disputants to move towards resolution. Each conflict must be looked at specifically and dealt with individually with the involved parties. Because of the many dynamics, no overall solution or formula for resolution can be provided. I would encourage students and clinical educators struggling with a difficult situation to contact the ACCE or DCE of the academic program for additional assistance in moving towards resolution of the conflict.

Kathleen M. Buccieri, PT, MS, PCS
Director of Clinical Education, Ithaca College

|Frequently asked questions:

Q: The student/CI does not seem to see things the same way that I do. How can we solve a problem that we see so differently? Why don’t they see this issue the same way that I do?

A: Several authors (Pinkley, Gleason, Petrosino) have reported on the positions we take in conflict. Some describe the past experiences that we have had as defining how we see things (our lens, mental model, or frame). Others look more broadly at how our generation was raised and what expectations we bring to the table (Gleason). (If the parties involved in conflict are from different generations, their perspective of the issue may vary greatly). The first step in moving towards a solution is for both parties to acknowledge the conflict and define it (Pinkley and Northcraft). Respectful conversations between the disputants can serve to clarify the situation, acknowledge each party’s concerns and establish motivation to resolve the issue at hand.

Q: What should be considered when attempting to come to agreement on the issue?

A: Pinkley (1990) defines three conflict frames that influence people’s interpretation of a conflict. Summarized here, with an example relevant to clinical education, it might be helpful to consider each disputants frame and be open to moving towards the other’s frame as information is shared.

1. Relationship vs task: A person with a relationship frame focuses on interpersonal concerns and their relationship with the person they are in conflict with. A person with a task orientation focuses on the material aspects of a dispute. For example a student might feel it is very important to build a good relationship with their CI, and be focused on doing so, perhaps at the expense of acknowledging their own clinical weaknesses. On the other hand, a student with a task orientation might be very focused on the grade for the affiliation and miss the importance of building a relationship with the patient and team.
2. Emotional vs intellectual: A person with an emotional frame focuses on the feelings involved versus someone with an intellectual frame who focuses on the actions and behaviors that occur. A clinical educator in a busy clinic may feel frustrated, stressed, even angry because of the time it takes to mentor a student who is struggling. Each ‘mistake’ the student makes may add to the feeling that there just are not enough hours in the day. It might be more advantageous for the clinical educator to attempt to adjust his/her frame to an intellectual one, leaving the emotions behind and focusing on prioritizing the actions and behaviors that can be addressed with the student.
3. Cooperate vs win: According to Pinkley, some disputants adopt a cooperate frame, seeing each party as responsible for the issue and therefore needing to compromise to reach solution, while others adopt a win frame, focusing on their own needs while blaming the other party. Some students who are struggling on affiliation may adopt a win frame as they focus on their own needs. They might feel low on the hierarchy of power in the clinic and desperate to succeed. We can help these students move towards a cooperate frame, by focusing on our availability and desire to offer assistance that might lead to their success.

Q: How can we clarify issues and positions?

A: It is sometimes very helpful to have the student journal their view of the situation(s) in question. This can help the CI interpret the student’s ‘frame’ and better understand the student’s position on the issue. The Clinical Instructor might also journal their perspective. The student and CI can then share journals with each other and perhaps gain a clearer understanding of the other’s thoughts and concerns.

An alternative strategy would be to perform an interim assessment of the student’s performance. The portion of the assessment tool that encompasses the area of concern could be completed by the CI and the student required to do a self assessment of the same area. Comparing results can be very enlightening and might produce specific examples of areas that need to be addressed.

Q: What if we still do not agree on the issues?

A: Sometimes it is okay to agree that you see things differently. The clinical instructor may need to define in measurable objectives the desired behavior and set consequences for failure to achieve. The CI can decide what ‘line of face’ to adopt (serious, nurturing, forceful) in order to motivate the student’s participation. If the disputants find themselves at this level, it might be helpful to bring in a third party (either the CCCE or the ACCE/DCE to mediate the conflict and assist in setting objectives for change).

Q: How do we decide on a solution?

A: Literature on negotiation theory suggests that the negotiation process take place face to face between the parties involved. Decision making rules should be determined at the outset (will negotiations continue until a win/win is achieved or is there a locus of control with one party outlining the solution to the other party)? When common agreement is reached as to the desired result, concrete steps can be outlined to achieve the result.

Consider meaningful alternatives to the behavior in question and brainstorm strategies to achieve the new behavior. Be sure to identify how you will measure change. How will you know when acceptable levels of performance have been reached?

Q: What are appropriate levels to expect?

A: Each academic program should provide the clinical site and the student with objectives to achieve at each level of affiliation. Due to variability in curriculums and sequencing, this is very individualized. Contact the Academic Coordinator of Clinical Education or the Director of Clinical Education to clarify levels of expectation for a specific student.

Q: What tools can assist in conflict resolution in clinical education of physical therapists?

A: The APTA Clinical Instructor Credentialing workshop is very helpful in this area. The workshop addresses conflict resolution and provides useful feedback forms to help structure the negotiation process. All clinical educators should consider taking the credentialing course.

The ACCE/DCE at the academic institution is a valuable resource to clinicians and students. Most programs have incident reports, weekly objectives and learning contracts that can be used as needed.

The sample behaviors listed under each criterion on the Clinical Performance Instrument give concrete examples of actions and abilities that should be considered in grading each criterion. They can be helpful in defining specifics for a student that needs motivation to see the value of changing a particular behavior. The student with a task or intellectual frame on a given issue might react favorably to seeing the desired behavior as part of their grade.

References:

Bazerman MH, Curhan JR, Moore DA, Valley KL, Negotiation, Annual Review of Psychology 2000: 51:279-314.

Pinkley RL, Northcraft GB, Conflict frames of reference: implications for dispute processes and outcomes, Academy of Management Journal, 1994, 37:193-205.

Gleason PG, Conflict resolution: managing age diversity, APTA Combined Sections Meeting, Boston, Feb 2002

Petrosino CL, Resolving conflict in the clinical setting, APTA Combined Sections Meeting, Boston, Feb 2002

Please feel free to submit additional questions on this topic by email below. We will make every attempt to reply in a timely manner.