Education Research: The medical student perspective on challenging conversations

Abstract

ObjectiveMedical students experience difficult conversations with patients during clinical clerkships. This study aimed to characterize barriers to and opportunities for learning in the setting of challenging conversations.MethodsNeurology clerkship medical students were enrolled prospectively in a concurrent nested mixed methods study. Qualitative data were collected using a postclerkship survey and semi-structured focus groups. Students were asked to reflect on challenging conversations they experienced with patients and to identify the top reasons why conversations were challenging. Responses were analyzed using directed content analysis.ResultsA total of 159 medical students were enrolled (MS2: n = 35 [22%]; MS3: n = 97 [61%]; MS4: n = 27 [17%]). Three themes of difficulty were identified in survey and focus group data: (1) tough clinical realities: how the clinical environment makes conversations challenging; (2) communication skill needs: the difficulty of finding the words to say; and (3) navigating emotions: of patients, clinicians, and students themselves. Tough clinical realities were cited by over two-thirds of students in all years (MS2: n = 30 [86%]; MS3: n = 74 [76%]; MS4: n = 23 [85%]). Communication skills needs were cited most frequently by third-year students (MS2: n = 15 [43%]; MS3: n = 55 [57%]; MS4: n = 10 [37%]). Students early in training were more likely to cite difficulty navigating emotions (MS2: n = 28 [80%]; MS3: n = 71 [73%]; MS4: n = 19 [70%]).ConclusionsMedical students frequently observe and participate in challenging conversations with patients. Here, students identified what makes these conversations most difficult. Communication curricula should leverage clinical communication encounters, prepare students for inherent clinical realities, and help students navigate emotions in the health care setting.

COVID-19 impact on neurology training program in Italy

“…For chronic neurological patients, the social restrictions had an important impact on their lives, and psychological consequences may have worsened their quality of life [ 14 ]. The lesson we have learned is that more space should be given during the training program to the acquisition of communication and psychological skills to reduce the burden of afflicted patients [ 15 ].…”

“…2b). Only 42% of residents (15), who already used tele-neurology before the pandemic, underwent a training course sponsored by their hospital.…”

COVID-19 Impact on Neurology Training Program in Italy

“…For chronic neurological patients the social restrictions had an important impact on their lives, and psychological consequences may have worsened their quality of life [13]. The lesson we have learned is that more space should be given during the training program to the acquisition of communication and psychological skills to reduce the burden of afflicted patients [14].…”

From threat to challenge—Improving medical students’ stress response and communication skills performance through the combination of stress arousal reappraisal and preparatory worked example-based learning when breaking bad news to simulated patients: study protocol for a randomized controlled trial

“…Therefore, patients’ emotional reactions to bad news can differ greatly—from perplexity, silence, and disbelief to intense displays of anger or sadness—and are thus very difficult for the physician to predict [ 1 , 4 ]. Even physicians who are frequently confronted with BBN regard it as highly demanding and stressful, and most often feel overwhelmed, uncomfortable, or insufficiently prepared [ 5 – 9 ]. Increased psychophysiological stress levels are observed in physicians during BBN encounters [ 6 , 8 ].…”