1. What medical students
are afraid of
in future clinical
interactions
Maggie Hammond
Division of Clinical Psychology
2.
3.
4. 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
5. • 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
6. Year 3:
• What else should we teach?
• When should we teach it?
• How should we teach it?
7. How challenging do you think
each of these situations will be
for you in your day-to-day
work when you are a doctor?
8. • 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
9. • 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
10. ITEM Mean (SD) Mode
Breaking bad news 4.1 (.86) 4
Discussing euthanasia/assisted suicide 4.1 (1.05) 5
Unexpected death of a patient 3.9 (.96) 4
Discussing DNR/hospice 3.7 (.94) 4
Confronting a colleague re: behaviour 3.6 (1.05) 4
Disclosing medical mistakes 3.6 (.89) 4
Angry patients/relatives 3.6 (.88) 4
Manipulative patients 3.4 (1.00) 3
Patients/families in denial 3.4 (.74) 4
Depressed patients/families 3.4 (.76) 3
Non-compliant patients 3.2 (.82) 3
Being honest but not taking away hope 3.1 (.90) 3
Managing own stress/burnout 3.0 (1.07) 3
14. Men = women
Item Mean (SD) mode
Patients who are non-compliant 3.2 (.82) 3
Patients or families who are 3.6 (.88) 4
angry
Patients or families who are 3.4 (.76) 3
depressed
Discussing DNR or hospice 3.7 (.94) 4
Requests for euthanasia/assisted 4.1 (1.05) 5
suicide
15. summary
1. They are already thinking about what might
be difficult in clinical practice
2. They are worried to different degrees, and by
different situations
3. There are differences in the types of
situations that concern students
4. Women express more concern than men
Particularly situations men least worried by, which
may be professional issues
16. Ideas
1. Address concerns as soon as possible; i.e.
Don’t leave difficult situations until 5th year
2. Determine why people worry about different
things: e.g. Personality, experience
3. Look more broadly at types of situations,
rather than individually
4. Do differences (esp. M vs F) persist into
Y5/F1/F2?
