Building De-escalation Communication Skills With Surgical Residents Utilizing Simulated Patient Methodology

Background: Surgery residents encounter patients in high-stress environments where emotions can quickly escalate to aggression or violence. Ongoing exposure can negatively impact a resident’s well-being and patient care. De-escalation communication training cultivates patient conflict management skills, but this is not routinely provided to surgery residents. Objective: To assess the efficacy of a simulation-based de-escalation communication training for surgical residents. Methods: At a large academic program, 16 Post-Graduate Year-1 and Post-Graduate Year-2 general surgery residents underwent a simulation-based de-escalation communication training in Fall 2024, composed of simulated patient cases interspersed with debriefs. The Essential Elements of Communication–Global Rating Scale and English-modified De-escalating Aggressive Behavior Scale assessed de-escalation skill building. Results: Of 21 residents, 16 (76%) participated, in which 55% were females, 56% white, and 44% had prior de-escalation training. Residents reported an increase in the mean number of de-escalation techniques attempted in each encounter from 3.3 ± 1.4 techniques in case 1.1 to 4.6 ± 1.3 techniques in case 2.2 ( P = 0.02), but a facilitator did not observe a significant difference ( P = 0.11). Mean Essential Elements of Communication–Global Rating Scale scores increased within the first (3.4 vs 3.9; P < 0.01) and second case (3.5 vs 3.9; P < 0.01) but not between the cases. De-escalating communication skills significantly increased throughout the simulation, with mean English-modified De-escalating Aggressive Behavior Scale scores increasing from 23.1 ± 2.6 in case 1.1 to 27.8 ± 2.7 in case 2.2 ( P = 0.003). Conclusions: A simulation-based de-escalation training with iterative debriefs and feedback helped surgical residents build these communication skills. This curriculum offers a foundation for integrating de-escalation training into surgical residency programs to enhance patient care and safety.