Education Research: Difficult conversations in neurology

Abstract

Objective To characterize features of medical student exposure to difficult conversations during a neurology core clerkship. MethodsThis was a cross-sectional concurrent nested mixed methods study, and all students rotating through a required neurology clerkship between 2014 and 2015 were enrolled. Data collection included an electronic communication tracker, baseline and end-of-clerkship surveys, and 4 facilitated focus groups. Students were asked to log exposure to patient-clinician conversations about (1) new disability, (2) poor prognosis, (3) prognostic uncertainty (4), terminal diagnosis, and (5) end-of-life care. ResultsA total of 159 students were enrolled and 276 conversations were tracked. Most (70%) students observed at least 1 difficult conversation, and conversations about poor prognosis, new disability, and prognostic uncertainty were most commonly logged. At clerkship end, most students (87%) desired additional bedside training in communication skills. Exposure to one of the predefined conversation types did not improve student perceived preparedness to lead difficult conversations in the future. In focus groups, students noted that the educational value of observation of a difficult conversation could be optimized with preconversation planning and postconversation debriefing. ConclusionsDifficult conversations are common in neurology, and represent a valuable opportunity to provide communication skills training on the wards. Future curricula should consider ways to leverage these existing opportunities to enhance communication skills training.

A realist review of advance care planning for people with multiple sclerosis and their families

“…Consequently, health professionals have a responsibility to train in communications skills [77] and specifically in engaging in difficult conversations [85]. Evidence suggests that people with MS prefer an active role in decision-making [86,87], therefore health professionals must work towards empowerment through partnerships.…”

Education Research: The medical student perspective on challenging conversations

“…5 In neurology clerkships, medical students frequently observe and participate in challenging conversations with patients. 4 In a prior study, we found that these encounters are valuable educational opportunities for students to gain real-time experience in communication skills, and that the difficult nature of these conversations presents both barriers to, and unique opportunities for, communication skills instruction. 4 This study was performed to understand the medical student perspective of participating in and observing challenging conversations, in order to inform future curricular design.…”

“…Many students will have their first real-life experiences with difficult conversations during their clinical rotations. Over half of medical students report directly participating in a difficult conversation during their clinical year 3,4 and as many as 29% of residents first delivered bad news to a patient during medical school. 5 In neurology clerkships, medical students frequently observe and participate in challenging conversations with patients.…”

“…Data were collected as part of a cross-sectional concurrent nested mixed-methods study. 4 Medical students at Johns Hopkins completing a required 4-week neurology core clerkship between August 2014 and March 2016 were eligible. At clerkship end, students were asked to reflect on challenging conversations they had encountered, including conversations about new disability, poor prognosis, uncertainty, terminal diagnosis, and end-of-life care.…”

Bedside Teaching in Neurology

“…This is particularly true in neurology, where the majority of students witness at least one difficult conversation about new disability or prognosis during their clerkship and residents participate in such conversations regularly. 36 Multiple studies have demonstrated role modeling to be among the most appreciated traits in highly respected clinical teachers, 16,19 though this is not uniformly the case. 29 Excellent clinical teachers consider this responsibility important and make conscious choices about which traits to model and how.…”