For clinicians, complicated interactions with patients and their families are not an if, but a when. And a first-year physician, who has the least experience handling agitated patients and their family members, is usually the first called when a situation escalates. 

Training in verbal de-escalation skills in med school is often less robust compared to other disciplines like nursing, says Jordan See, former educator at Pitt Med, now at the University of Pennsylvania. So in the moment, it’s not uncommon for a young doctor to forget what they’ve learned. 

“When you’re in a situation like that, emotions are really high,” says See, an MD, MS. “It’s like being a deer in the headlights.” 

Since 2023, Pitt Med has taught the CALMER Conflict Curriculum, based on a mnemonic device developed by See with a team that included Reed Van Deusen, assistant dean for human simulation education and MD, MS associate professor of medicine, and Anna Donovan, an MD, MS associate professor of medicine. CALMER stands for calm tone and pace, acknowledge/agree, listen actively, mirror, empower with choices and responsibility. At Pitt Med, it’s used in a simulation with a standardized patient (or SP)—someone who’s trained to portray a patient or family member and their symptoms or behaviors. 

Surveys have shown that students felt more confident after completing CALMER. Penn and the University of Wisconsin have adopted it. 

In a recent session at Pitt Med, a group meets a patient’s frustrated daughter. After a long drive to the hospital, she learned that her mother’s procedure was rescheduled—leading to an extended hospital stay for the patient and a daughter at her wit’s end. 

When the facilitator announces the beginning of the simulation, the SP comes at the graduating med student full force with pointed fingers, a raised voice and a counterargument to proposed solutions. 

The student offers a smile to the SP. 

“Do you think this is funny?” the SP says back.  

“Time!” calls the facilitator. The SP shuts down in the corner like a decommissioned robot. 

“What could you have done better?” the facilitator asks. 

The student checks in with peers and reflects, then acknowledges that his body language was defensive and his nervous smile was misread. They try again after another CALMER debrief. The student validates the SP by recognizing her long drive. The SP starts to give in—even offering some information about her mother’s living conditions. 

“Time,” again calls the facilitator. “We’re getting somewhere.” 

Read more from the Summer 2025 issue.