CALMER Conflict: A Novel Curriculum for Graduating Medical Students to Manage and Defuse Patient-Provider Conflict

Area of Science:

• Medical Education
• Healthcare Professional Training
• Patient Safety

Background:

• Workplace violence, including verbal aggression from patients, is prevalent among healthcare workers.
• Verbal de-escalation is a primary strategy for managing patient anger, yet undergraduate medical education lacks standardized curricula and evaluation methods.
• Existing training gaps necessitate the development of effective de-escalation skill programs for future physicians.

Purpose of the Study:

• To create and assess a medical school curriculum focused on de-escalation techniques for adult patients.
• To evaluate the curriculum's effectiveness using pre- and post-intervention surveys and an objective structured clinical examination (OSCE).

Main Methods:

• A novel curriculum, incorporating an interactive didactic based on the CALMER framework and a standardized patient practice session, was implemented in a "Get Ready for Residency Bootcamp."
• Forty-four fourth-year medical students participated in the curriculum, which emphasized six evidence-based de-escalation skills.
• Effectiveness was measured through post-curriculum surveys (82% response rate) and an OSCE.

Main Results:

• Surveys indicated a significant increase in student confidence in using verbal de-escalation skills, rising from 2.79 to 4.11 (p ≤ 0.001).
• Student preparedness improved across all de-escalation skills, with high curriculum satisfaction (average 4.79/5).
• The OSCE did not reveal significant differences in skill levels between students who completed the curriculum and those who did not.

Conclusions:

• The developed de-escalation curriculum is evidence-based, replicable, and effectively enhances medical student confidence and preparedness in managing agitated patients.
• While confidence and perceived preparedness increased, further refinement and objective assessment methods may be needed to demonstrate skill transfer in OSCE settings.
• This program offers a valuable model for integrating essential de-escalation training into undergraduate medical education to improve patient safety and healthcare worker well-being.