Benefits of Teaching Medical Students How to communicate with Patients Having Serious Illness comparison of Two approaches to Experiential, Skill-Based, and Self-reflective Learning


2013-02-08 | Admin MKKI

Matthew S. Ellman, MD*, and Auguste H. Fortin VI, MD, MpH
Yale School of Medicine, New Haven, Connecticut
Innovative approaches are needed to teach medical students effective and compassionate communication with seriously ill patients. We describe two such educational experiences in the Yale Medical School curriculum for third-year medical students: 1) Communicating Difficult News Workshop and 2) Ward-Based End-of-life Care Assignment.

These two programs address educational needs to teach important clinical communication and assessment skills to medical students that previously were not consistently or explicitly addressed in the curriculum. The two learning programs share a number of educational approaches driven by the learning objectives, the students’ development, and clinical realities. Common educational features include: experiential learning, the Biopsychosocial Model, patient-centered communication, integration into clinical clerkships, structured skill-based learning, self-reflection, and self-care. These shared features ? as well as some differences ? are explored in this paper in order to illustrate key issues in designing and implementing
medical student education in these areas.

Background
An aging population and advances in medical technology result in more challenges for physicians to meet the needs and goals of patients living with advanced disease.

To address these challenges, medical students must learn to communicate effectively and compassionately with patients who have complex and serious illness.

Studies have shown that graduating medical students do not consistently feel prepared to communicate with and care for patients in difficult clinical situations and at the end of life [1-3]. For example, a national survey of a sample of 1,455 fourthyear medical students from 62 U.S. medical schools showed that students’ education in
end-of-life care was especially lacking in the aspects of communication and empathy.

In this study, 48 percent of students reported having never received feedback about giving bad news, and 53 percent were never given feedback about a discussion of wishes for care at the end of life [2].In the pre-clinical years, students will not be prepared to grasp and put these communication skills in context without having had exposure to seriously ill patients and medical care on the wards.

 While on the wards during clinical clerkships, students have inconsistent exposure and training in these communication and assessment skills. Mentors on the wards may not have had education or training themselves to enable them to be optimal role models [4]; indeed,a recent study showed that attending physicians do not use patient-centered skills when breaking difficult news to patients,
but avoid psychosocial issues and focus instead on providing medical information [5]. Regardless, the encounters students witness are memorable (either positively or negatively) and important for their professional formation [6].

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