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August 8, 1986

Recognition and Management of Discord Within House Staff Teams

Author Affiliations

From the Child Psychiatry, Children's, and Psychiatry Services, Massachusetts General Hospital, and the Departments of Pediatrics and Psychiatry, Harvard Medical School, Boston.

JAMA. 1986;256(6):754-755. doi:10.1001/jama.1986.03380060080030

A WELL-FUNCTIONING house staff team is essential to inpatient care and teaching. The skills of working together and team management are not taught directly but are handed down through the house staff or learned by identification with members of the faculty. Although these indirect methods of teaching are often sufficient, they do not address important affective issues such as team morale or interpersonal tension. Under stressful circumstances the level of tension within a team can rise, causing individuals to feel angry and impairing the team's ability to function.

The observations presented in this study are based on numerous consultations to intensive care and other teams in distress and weekly rounds that have included approximately 100 senior pediatric residents leading teams.

House staff teams commonly try to avoid acknowledging when stress or interpersonal tensions become discord. Often, conflict can be a well-kept secret. Although nursing staff are aware of the hostility