"Tell Me About a Time You Disagreed with an Attending": Structuring Your Answer

This question makes candidates nervous for good reason. Answer poorly, and you sound either insubordinate or like a pushover. Answer well, and you demonstrate clinical judgment, communication skills, and professional maturity.

Here's how to nail it.

What They're Really Asking

This isn't a trick question. Interviewers want to know:

1. Do you think independently? APPs who never question anything aren't providing value
2. Can you communicate respectfully? Disagreement is inevitable; conflict resolution skills matter
3. Do you prioritize patient safety? The right answer always centers on the patient
4. Are you a team player? Can you disagree without being disagreeable?

The STAR Framework

Structure your answer using STAR:

• Situation: Set the scene briefly
• Task: What was your responsibility?
• Action: What did you do?
• Result: What happened?

The Ideal Answer Structure

Opening (10 seconds)

Briefly set up the clinical scenario without excessive detail.

The Disagreement (15 seconds)

Clearly state what you observed and why you had concerns.

Your Approach (30 seconds)

This is the meat of your answer—how you communicated your concern.

The Resolution (15 seconds)

What happened? (Ideally, the patient benefited.)

The Reflection (10 seconds)

What did you learn? How did it affect the relationship?

Example Answers

Example 1: Clinical Disagreement (Resolved Positively)

Situation: "I was caring for a 68-year-old patient with COPD exacerbation who was on BiPAP but clinically deteriorating. The overnight attending wanted to continue the current management."

Task: "I was responsible for this patient's care and was concerned we were heading toward an emergent intubation if we didn't act."

Action: "I asked if we could discuss the case briefly. I shared my specific concerns—the patient's work of breathing had increased, his pH had dropped from 7.31 to 7.26, and he was becoming more confused. I said, 'I'm worried we're on a trajectory toward emergent intubation, and I wanted to discuss whether elective intubation might be safer right now.'

The attending listened and shared their reasoning—concern about getting him off the vent given his baseline. We discussed it and agreed on a middle ground: we'd try one more intervention—increasing the BiPAP settings and adding a bronchodilator—with clear parameters for intubation if he didn't improve within an hour."

Result: "The patient did improve with the adjusted settings and avoided intubation. But more importantly, we had established a shared mental model and clear triggers for escalation."

Reflection: "That experience reinforced for me that respectfully voicing concerns, with specific data, leads to better collaborative decisions. The attending and I actually developed a stronger working relationship after that."

Example 2: Disagreement Where You Were Wrong

Sometimes the best answer is one where you disagreed, were proven wrong, and learned from it.

Situation: "Early in my ICU career, I had a patient with septic shock who wasn't responding to fluid resuscitation. I thought we should be more aggressive with pressors."

Task: "I wanted to advocate for what I thought was best for the patient."

Action: "I respectfully shared my concern with the attending. She took time to explain her reasoning—the patient had underlying diastolic heart failure, and she was concerned about fluid overload. She walked me through the CVP trends and her approach of 'small pushes' rather than aggressive resuscitation."

Result: "The patient stabilized with her approach. I realized I had been thinking textbook sepsis without adequately considering comorbidities."

Reflection: "That taught me to always consider the individual patient context and to ask questions when I don't understand an approach, rather than assuming I know better. It also showed me the value of attendings who take time to teach."

Example 3: Disagreement About System/Process

Not all disagreements are about clinical decisions.

Situation: "Our unit had a handoff process that I felt was creating information gaps—critical labs were sometimes missed between shifts."

Task: "I wanted to improve patient safety, but I needed to do so constructively."

Action: "Rather than just complaining, I documented specific near-misses over a two-week period. I requested a brief meeting with the medical director and presented the data along with a proposed solution—adding a structured lab review section to our handoff template."

Result: "The medical director agreed the data was concerning. We piloted the new template, which is now standard practice on the unit."

Reflection: "I learned that data-driven concerns with proposed solutions are received much better than vague complaints."

Key Phrases to Use

Opening the conversation:

• "Can I share a concern about..."
• "I want to make sure I understand the plan because..."
• "I'm seeing something that's worrying me..."

Presenting your perspective:

• "My concern is..."
• "What I'm observing is..."
• "I may be missing something, but..."

Showing collaboration:

• "What are your thoughts on..."
• "Help me understand..."
• "I want to make sure we're on the same page..."

What NOT to Say

• "The attending was totally wrong" (never badmouth)
• "I knew better than them" (arrogance)
• "I just did what I thought was right anyway" (insubordination)
• "I've never disagreed with an attending" (unbelievable)
• Anything involving going over the attending's head without attempting dialogue first

If You're Asked: "What If the Attending Didn't Listen?"

Be prepared for this follow-up. Good answer:

"If I had significant concerns about patient safety and felt they weren't being addressed, I would clearly document my concerns and the discussion. If it was truly urgent, I would escalate appropriately—to the medical director or through the chain of command. Patient safety has to come first, while still respecting the collaborative relationship."

Practice Makes Perfect

Before your interview:

1. Identify 2-3 real examples from your experience
2. Practice telling them out loud (not just in your head)
3. Time yourself—aim for 90 seconds to 2 minutes
4. Ask a colleague to give feedback

The Bottom Line

This question is an opportunity to demonstrate mature professional judgment. Show that you think critically, communicate respectfully, prioritize patients, and can work through disagreements collaboratively. The best APPs aren't yes-men—they're thoughtful advocates who know how to voice concerns effectively.

Choose an example that shows your clinical reasoning and communication skills, not one that makes you look like a hero at someone else's expense.