William N. Levine, MD, FAAOS | Amiethab Aiyer, MD, FAAOS, FAOA
June 26, 2026
Got a topic you’d like to see in a future post? Submit your ideas here.
One of the biggest surprises of residency is that conflict is not something to avoid. It is something to learn from.
As orthopedic residents, we spend five years working closely with the same group of attendings, fellows, co-residents, nurses, and staff. We learn together, operate together, and sometimes disagree with one another. For interns and PGY2s especially, those disagreements can feel intimidating. Nobody wants to be labeled as difficult, but nobody wants to compromise patient care or professional integrity either. The challenge is finding a way to navigate conflict without damaging relationships that will shape the rest of your training.
As an intern, most conflicts are not really conflicts at all. They are usually the result of inexperience, miscommunication, or differing expectations. You are learning a new language, a new workflow, and a new culture all at once. At a place like Columbia, where the pace is fast and expectations are high, it is easy to interpret a blunt comment or correction as criticism. Often, however, it reflects the urgency of the moment rather than a judgment of you as a person.
One lesson I learned early was to focus on the message rather than the delivery. The operating room, fracture conference, and overnight consults are not always environments where feedback arrives wrapped in a bow. Sometimes it comes quickly and directly. If you can resist the urge to become defensive and instead ask yourself what you can learn from the interaction, you will grow much faster.
By PGY2, the nature of conflict changes. You are no longer simply carrying out tasks. You are beginning to make decisions, supervise interns, and develop your own clinical judgment. This is often the first time you may see a situation differently than a senior resident or attending. Those moments can be uncomfortable, but they are also important.
I have found that the most effective approach is curiosity rather than confrontation. Asking, “Can you help me understand your thinking?” often opens a productive conversation. Framing concerns around patient care rather than opinion also goes a long way. Most disagreements become easier to navigate when everyone remembers they are ultimately working toward the same goal.
Timing matters too. Challenging a decision in the middle of a busy clinic or a complex case is rarely productive. If something truly needs clarification, a private conversation afterward is usually more effective and better received. Some of the most meaningful teaching moments in residency happen after the dust settles when there is space for honest discussion.
Perhaps the most important perspective for junior residents is recognizing that residency is a marathon, not a sprint. The attending who pushes you the hardest today may become your strongest advocate when you apply for fellowship. The senior resident who seems demanding may be the person you call for advice years later. Orthopedics is a small community, and reputations are built over time.
Being respectful does not mean being passive. Being confident does not require being combative. The residents who navigate conflict best are often the ones who listen first, remain professional under pressure, and approach disagreements with humility and curiosity.
The reality is that conflict is unavoidable in training. Burning bridges is not. If handled thoughtfully, those challenging conversations often become the experiences that teach us the most and strengthen the relationships that matter throughout our careers.
DISCLOSURES: Dr. Levine is on the Columbia faculty. Dr. Levine serves as a paid consultant and surgeon designer for Zimmer Biomet. International Board of Shoulder and Elbow Surgery – Treasurer : Type: Board of Directors or committee member: Self Dr. Aiyer American Orthopaedic Foot and Ankle Society: Board or committee member, Delee & Drez Orthopaedic Sports Medicine (Elsevier): Publishing royalties, financial or material support, Journal of Bone and Joint Surgery – British: Editorial or governing board, Miller’s Review of Orthopaedics (Elsevier): Publishing royalties, financial or material support, JAAOS (Wolter Kluvers): Editorial Board, AAOS/Orthomentor Survival Guide for Orthopaedic Rotations: Publishing royalties, financial or material support, Enovis: consulting/royalties, Vilex: consulting/royalties, GLW: consulting/royalties
Read the AAOS Code of Conduct for Discussion Group Terms, Conditions and Disclaimers HERE.
Copyright© 2026 by the American Academy of Orthopaedic Surgeons