What medical students are afraid of in future clinical interactions Maggie Hammond Division of Clinical Psychology
Communication for clinical practice for medical students• Year 1: – basics: opening and closing a consultation, listening, recognising and responding to emotions, giving information, checking for understanding; work with actors,• Year 2: – Doctor-led vs. patient-led consultations; reflection on improving consultations
• Year 3: – Deaf awareness training, improving the quality of history taking, talking about health behaviour change• Year 4: – Three full days, with actors, in palliative care setting• Year 5: – Challenges: anger, violence, complaints, mistakes
Year 3:• What else should we teach?• When should we teach it?• How should we teach it?
How challenging do you think each of these situations will be for you in your day-to-day work when you are a doctor?
• Breaking bad news• Being honest but not taking away hope• Patients or families who are angry• Patients or families who are depressed• Patients or families in denial• Patients who are manipulative• Patients who are non-compliant• Discussing ‘Do Not Resuscitate’ and/or hospice• Requests for euthanasia or assisted suicide• Unexpected death of a patient• Confronting a colleague about undesirable behaviour• Managing your own stress levels / avoiding burn-out• Disclosing harmful medical mistakes
• Three cohorts (2008, 2009, 2010)• 48% (n=422; 244 female) returned valid surveys.• Cronbach’s Alpha for all items: 0.81• Mean total: 46.1 (SD 6.6), min 13, max 65
ITEM Mean (SD) ModeBreaking bad news 4.1 (.86) 4Discussing euthanasia/assisted suicide 4.1 (1.05) 5Unexpected death of a patient 3.9 (.96) 4Discussing DNR/hospice 3.7 (.94) 4Confronting a colleague re: behaviour 3.6 (1.05) 4Disclosing medical mistakes 3.6 (.89) 4Angry patients/relatives 3.6 (.88) 4Manipulative patients 3.4 (1.00) 3Patients/families in denial 3.4 (.74) 4Depressed patients/families 3.4 (.76) 3Non-compliant patients 3.2 (.82) 3Being honest but not taking away hope 3.1 (.90) 3Managing own stress/burnout 3.0 (1.07) 3
Total scores:• Women: mean 47.1, SD 6.6• Men: mean 44.6, SD 6.2
Men = womenItem Mean (SD) modePatients who are non-compliant 3.2 (.82) 3Patients or families who are 3.6 (.88) 4angryPatients or families who are 3.4 (.76) 3depressedDiscussing DNR or hospice 3.7 (.94) 4Requests for euthanasia/assisted 4.1 (1.05) 5suicide
summary1. They are already thinking about what might be difficult in clinical practice2. They are worried to different degrees, and by different situations3. There are differences in the types of situations that concern students4. Women express more concern than men Particularly situations men least worried by, which may be professional issues
Ideas1. Address concerns as soon as possible; i.e. Don’t leave difficult situations until 5th year2. Determine why people worry about different things: e.g. Personality, experience3. Look more broadly at types of situations, rather than individually4. Do differences (esp. M vs F) persist into Y5/F1/F2?