Potential Responses to Difficult Team Interactions: INTERVENE
The following is taken from research on a curriculum to foster medical student resilience published by Bird et al. (2020):
INTERVENE
The following acronym describes steps to work with challenges when they occur in a team:
| I | Intervene early |
| N | Note the best management strategy |
| T | Think through other factors at play |
| E | Elect the encounter |
| R | Regulate the amount of feedback |
| V | Verify the common goal |
| E | Explore intentions |
| N | Narrate specific examples and provide alternatives |
| E | Enlist help from others |
Details of the INTERVENE steps:
I Intervene early
Early interventions make a useful response easier. For example, a 3rd-year clerkship student notices that the senior resident on a clinic rotation only talks with the intern about patient updates. So the student feels they are missing out on this educational opportunity. If they ask to be included in a timely way, they may get the educational experience they want; if they wait until the end of the rotation and complain when asked for feedback, they miss out on the educational opportunity.
N Note the best management strategy.
Different situations call for different strategies. Options include:
- Avoid – Denying the existence of conflict. May be okay in the very short term, such as for 1 shift overlap
- Accommodate – Letting the other party decide
- Adaptation – Working with or around differences
- Compete – Aggressively pursuing ways to achieve your win
- Collaborate – Actively looking after your own interests but not losing sight of the interests of others. Best for 2 students on the same team. (Saltman et al., 2006; Bird, 2020).
T Think through the factors at play.
Don’t take it personally. Examples of factors involved in difficult team interactions include personal factors that can lead to conflict (Lorenzetti et al., 2013):
- Attitudes and Mental health/Well-being status – Burnout, insecurity, uncertainty, negative bias, anxiety/depression
- Conditions – Time pressure, sleep deprivation, overwork, personal health problems, situation stressors
- Knowledge – Limited medical knowledge, limited knowledge about teamwork
- Skills – Difficulty with communication, easy frustration, difficulty expressing empathy, difficulty providing effective and respectful feedback For example, a senior clinician may neglect to take the time to teach you something due to a competing priority, such as a patient’s well-being. They may be caught up in the demands of doing their job well and not intentionally slighting you. They may be not well-trained in giving constructive feedback or have character flaws or limitations in emotional intelligence that have nothing to do with you, etc.
E Elect the encounter.
Choose an appropriate setting and time for discussion of the difficulty.
R Regulate the amount of feedback.
Think about what is most important. There are situations where it is appropriate to provide constructive feedback to another team member, keeping the team goal in mind, so that the team can function better and achieve its goal. In other situations, venting your frustrations when nothing good will come of it may not be a good idea; it may be best to talk with a trusted peer.
V Verify the common goal.
See the larger mission for the team. Is the goal you are trying to achieve an agreed upon goal of the whole team? Junior members of the team can respectfully check with senior members to clarify their understanding the team goal. It may be that you need to be more flexible than you realized.
E Explore intentions.
Don’t assume the intentions of others. Consider the possibility that what seems like an obvious intention may not be accurate. If it is possible to discuss productively and respectfully, exploring the intentions of the other person may be helpful.
N Narrate specific examples and provide alternatives.
Point out specific examples of problem actions/behavior. Giving concrete examples is important, so that team members understand the problem. Offer an alternative that you think would be effective. Note that you cannot request a change in personality.
E Enlist help from others.
When needed, get the right help involved. Some possibilities are the resident, intern, attending, chief resident, clerkship director, dean, ombudsmen, fellow students, career advisor, faculty mentor, supervisor, etc. However, many students say that they prefer to talk with peers about the stresses of medical school.
Source (with minor changes):
- Bird A, Tomescu O, Oyola S, Houpy J, Anderson I, Pincavage A. A curriculum to teach resilience skills to medical students during clinical training. MedEdPORTAL.2020;16:10975. https://doi.org/10.15766/mep_2374-8265.10975 Appendix D. Lesson Plan – Difficult Team References
- Bird, A. Tomescu, O. Pincavage, A.: A Novel Medical Student-Driven Multicenter Resilience Curriculum. Society for General Internal Medicine : 2018.
- Bird Amber, Tomescu Oana, Oyola Sonia, Houpy Jennifer, Anderson Irsk, Pincavage Amber. A Curriculum to Teach Resilience Skills to Medical Students During Clinical Training. MedEdPORTAL. 2020;16:10975. doi:10.15766/mep_2374-8265.10975. PMID: 33015355 PMCID: PMC7526502.
- Lorenzetti C, Jacques CHM, Donovan C, Cottrell S, Buck J. Managing Difficult Encounters: Understanding Physician, Patient, and Situational Factors. Am Fam Physician. March 15, 2013;87(6):419-425. PMID: 23547575.
Appreciative Inquiry: Appreciate What Is Good on Your Team
Appreciative Inquiry Principles: To Foster Positive Organizational Culture (Review of an AMA course)
This course, offered by the AMA, aims to build a positive organizational culture in medicine by asking unconditional, positive questions to identify what is best in the organization. The subtitle sums up the general approach: Ask “What Went Well?” to foster positive organizational culture, as opposed to starting with or always emphasizing “What Went Wrong?” This approach can be applied to medical teams, for example, the one you are assigned to in a clerkship. The course recommends asking the following questions about an organization, for example:
• What is something that went well for you today?
• What was a success that you had recently?
• Can you tell me about a recent positive experience in your work or personal life?
• Has a patient or family member told you that you made a difference?
• How do you help to make our workplace more productive and positive?
• Have you noticed a team member go beyond the call of duty sometime this week?
• Can you recall a situation this week in which you had a chance to learn and grow?
• Think of a recent successful team project. What made the team so successful?
Try asking yourself the above questions about your team, especially if you are having difficult interactions with them.
Source:
May N,Becker D, Frankel R, Haizlip J, Harmon R, Plews-Ogan M, et al.AppreciativeInquiry in Health Care: Positive Questions to Bring Out the Best.Brunswick, Ohio: Crown Custom Publishing, Inc.; 2011.
AMA.Practice transformation series: using appreciative inquiry to foster a positive organizational culture. 2016.
From: AMA. Appreciative Inquiry. Stepsforward. AMA Ed Hub. August 31, 2016.
