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Erschens R, Skrypski I, Festl-Wietek T, Herrmann-Werner A, Adam SH, Schröpel C, Nikendei C, Zipfel S, Junne F. Insights into discrepancies in professional identities and role models in undergraduate medical education in the context of affective burden. Front Psychiatry 2024; 15:1358173. [PMID: 38757136 PMCID: PMC11097199 DOI: 10.3389/fpsyt.2024.1358173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/22/2024] [Indexed: 05/18/2024] Open
Abstract
Introduction International evidence strongly suggests that medical students are at high risk of mental health problems. This distress, which can be mediated by a variety of individual, interpersonal and contextual factors within the curriculum, can be mitigated by effective coping strategies and interventions. Central to this discourse is the recognition that the challenges of professional identity formation can contribute significantly to medical students' distress. The focus of our study is therefore to examine discrepancies in professional identities and role models in undergraduate medical education in relation to affective burden. Methods Medical students at different stages of university education and high school graduates intending to study medicine were surveyed in a cross-sectional study. The study employed Osgood and Hofstätter's polarity profile to evaluate the self-image of participants, the image of an ideal and real physician, and their correlation with depression (PHQ-9) and anxiety (GAD-7). Results Out of the 1535 students recruited, 1169 (76.2%) participated in the study. Students rated their self-image as somewhere between a more critical real image of physicians and a more positive ideal image. Medical students at all training levels consistently rated the ideal image as remaining constant. Significant correlations were found between the professional role models of medical students and affective symptoms, particularly for the discrepancy between the ideal image of a physician and their self-image. Furthermore, 17% and nearly 15% reported significant symptoms of depression and anxiety, respectively. Discussion Our study adds to the growing body of knowledge on professional identity formation in medicine and socialisation in the medical environment. The study highlights the importance of discrepancies between self-image and ideal image in the experience of depressive and anxiety symptoms. Primary prevention-oriented approaches should incorporate these findings to promote reflective competence in relation to professional role models and strengthen the resilience of upcoming physicians in medical training.
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Affiliation(s)
- Rebecca Erschens
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, University of Tübingen, Tübingen, Germany
| | - Isabelle Skrypski
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, University of Tübingen, Tübingen, Germany
| | - Teresa Festl-Wietek
- Tübingen Institute for Medical Education, University of Tübingen, Tübingen, Germany
| | - Anne Herrmann-Werner
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, University of Tübingen, Tübingen, Germany
- Tübingen Institute for Medical Education, University of Tübingen, Tübingen, Germany
| | - Sophia Helen Adam
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, University of Tübingen, Tübingen, Germany
| | - Carla Schröpel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, University of Tübingen, Tübingen, Germany
| | - Christoph Nikendei
- Department for General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, University of Tübingen, Tübingen, Germany
- Deanery of Students’ Affairs, University’s Faculty of Medicine, Tuebingen, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, University of Tübingen, Tübingen, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Otto von Guericke University Magdeburg, University Hospital Magdeburg, Magdeburg, Germany
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Gameiro S, Adcock E, Graterol Munoz C, O’Hanrahan M, D’Angelo A, Boivin J. What is bad news in fertility care? A qualitative analysis of staff and patients' accounts of bad and challenging news in fertility care. Hum Reprod 2024; 39:139-146. [PMID: 37968233 PMCID: PMC10767966 DOI: 10.1093/humrep/dead231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 10/11/2023] [Indexed: 11/17/2023] Open
Abstract
STUDY QUESTION What do fertility staff and patients think is bad news in fertility care? SUMMARY ANSWER Staff and patients agree bad news is any news that makes patients less likely to achieve parenthood spontaneously or access and do successful treatment, but their appraisals of how bad the news is are differently influenced by specific news features and the context of its delivery. WHAT IS KNOWN ALREADY Bad news is common in fertility care, but staff feel unprepared to share it and four in 10 patients react to it with unanticipated emotional or physical reactions. Research has paid much attention to how bad news should be shared, but considerably less to what news is perceived as bad, despite the fact this may dictate elements of its delivery. STUDY DESIGN, SIZE, DURATION Two cross-sectional, online, mixed-method surveys (active 7 January-16 July 2022) were distributed to fertility staff and patients across the UK and Europe. PARTICIPANTS/MATERIALS, SETTING, METHODS Staff inclusion criteria were being a healthcare professional working in fertility care and having experience of sharing bad news at least once a month. Patients' inclusion criteria were being adults and having had a conversation in which staff shared or explained bad news concerning their fertility care within the last 2 months. Surveys were created in English using Qualtrics, reviewed by patients and healthcare professionals, and distributed via social media, Prolific, fertility organizations, and scientific societies. Patients were asked, regarding the last time bad news were shared with them, 'What was the bad news?' and 'What other news would you consider bad news in fertility care?'. Staff were asked to 'List the three most challenging topics of bad news you share with your patients'. Staff and patient data were separately thematically analysed to produce basic codes, organized into sub-themes and themes. Themes emerging from patients' and staff data were compared and synthesized into meta themes. MAIN RESULTS AND THE ROLE OF CHANCE Three hundred thirty-four staff accessed the survey, 286 consented, and 217 completed (65% completion rate). Three hundred forty-four patients accessed the survey, 304 consented, and 222 completed (64% completion rate). Eighty-five percent of participants were women, 62% resided in Europe, and 59% were in private care. Average staff age was 45.2 (SD = 12.0), 44% were embryologists or lab technicians, 40% were clinicians (doctors, consultants, or physicians), and 8% nurses or midwifes. Average patient age was 32.2 (SD = 6.4) and 54% had children. Staff answers originated 100 codes, 19 sub-themes and six themes. Patients' answers produced 196 codes, 34 sub-themes, and 7 themes. Staff and patient themes were integrated into three meta-themes reflecting main topics of bad news. These were Diagnosis and negative treatment events and outcomes, Inability to do (more) treatment, and Care and patient factors disrupting communication. Staff and patients agreed that some news features (uncertain, disruptive, definitive) made news more challenging but disagreed in relation to other features (e.g. unexpected/expected). Patient factors made bad news more challenging to staff (e.g. difficult emotions) and care factors made bad news more challenging to patients (e.g. disorganized care). LIMITATIONS, REASONS FOR CAUTION Participants were self-selected, and most were women from private European clinics. Questions differed for staff and patients, focused on subjective perceptions of news, and did not measure news impact. WIDER IMPLICATIONS OF THE FINDINGS The badness of fertility news is not only a product of the extent to which the news compromises parenthood goals but also of its features (timing, nature, number) and the context in which the news is delivered. Guidance on sharing bad news in fertility care needs to go beyond easing the process for patients to also consider staff experiences. Guidance may need to be tailored to news features and context. STUDY FUNDING/COMPETING INTEREST(S) Cardiff University funded the research. S.G., J.B., O'.H., and A.D. report funding from the Higher Education Funding Council for Wales and the European Society for Human Reproduction and Embryology (ESHRE) to develop fertiShare: a sharing bad news eLearning course for fertility care. fertiShare will be distributed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International Licence (CC BY-NC-SA 4.0). No other conflicts are reported in relation to this work. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- S Gameiro
- Cardiff Fertility and Reproductive Research Group, School of Psychology, Cardiff University, Wales, UK
| | - E Adcock
- School of Medicine, Cardiff University, Wales, UK
| | | | - M O’Hanrahan
- School of Psychology, Cardiff University, Wales, UK
| | - A D’Angelo
- School of Medicine, Cardiff University, Wales, UK
- Wales Fertility Institute, Swansea Bay University Health Boards, Wales, UK
| | - J Boivin
- Cardiff Fertility and Reproductive Research Group, School of Psychology, Cardiff University, Wales, UK
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Li H, Upreti T, Do V, Dance E, Lewis M, Jacobson R, Goldberg A. Measuring wellbeing: A scoping review of metrics and studies measuring medical student wellbeing across multiple timepoints. MEDICAL TEACHER 2024; 46:82-101. [PMID: 37405740 DOI: 10.1080/0142159x.2023.2231625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
PURPOSE Studies have demonstrated poor mental health in medical students. However, there is wide variation in study design and metric use, impairing comparability. The authors aimed to examine the metrics and methods used to measure medical student wellbeing across multiple timepoints and identify where guidance is necessary. METHODS Five databases were searched between May and June 2021 for studies using survey-based metrics among medical students at multiple timepoints. Screening and data extraction were done independently by two reviewers. Data regarding the manuscript, methodology, and metrics were analyzed. RESULTS 221 studies were included, with 109 observational and 112 interventional studies. There were limited studies (15.4%) focused on clinical students. Stress management interventions were the most common (40.2%). Few (3.57%) interventional studies followed participants longer than 12 months, and 38.4% had no control group. There were 140 unique metrics measuring 13 constructs. 52.1% of metrics were used only once. CONCLUSIONS Unique guidance is needed to address gaps in study design as well as unique challenges surrounding medical student wellbeing surveys. Metric use is highly variable and future research is necessary to identify metrics specifically validated in medical student samples that reflect the diversity of today's students.
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Affiliation(s)
- Henry Li
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Tushar Upreti
- Max Rady College of Medicine, Faculty of Health Sciences, University of Manitoba Rady, Winnipeg, Canada
| | - Victor Do
- Department of Pediatrics, Faculty of Medicine, University of Toronto Temerty, Toronto, Canada
| | - Erica Dance
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Melanie Lewis
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Ryan Jacobson
- Office of Advocacy and Wellbeing, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Aviva Goldberg
- Department of Pediatrics and Child Health, Faculty of Health Sciences, University of Manitoba Rady, Winnipeg, Canada
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Ahn BT, Maurice-Ventouris M, Bilgic E, Yang A, Lau CHH, Peters H, Li K, Chang-Ou D, Harley JM. A scoping review of emotions and related constructs in simulation-based education research articles. Adv Simul (Lond) 2023; 8:22. [PMID: 37717029 PMCID: PMC10505334 DOI: 10.1186/s41077-023-00258-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 07/17/2023] [Indexed: 09/18/2023] Open
Abstract
BACKGROUND While acknowledgement of emotions' importance in simulation-based education is emerging, there are concerns regarding how education researchers understand the concept of emotions for them to deliberately incorporate emotionally charged scenarios into simulation-based education. This concern is highlighted especially in the context of medical education often lacking strong theoretical integration. To map out how current simulation-based education literature conceptualises emotion, we conducted a scoping review on how emotions and closely related constructs (e.g. stress, and emotional intelligence) are conceptualised in simulation-based education articles that feature medical students, residents, and fellows. METHODS The scoping review was based on articles published in the last decade identified through database searches (EMBASE and Medline) and hand-searched articles. Data extraction included the constructs featured in the articles, their definitions, instruments used, and the types of emotions captured. Only empirical articles were included (e.g. no review or opinion articles). Data were charted via descriptive analyses. RESULTS A total of 141 articles were reviewed. Stress was featured in 88 of the articles, while emotions and emotional intelligence were highlighted in 45 and 34 articles respectively. Conceptualisations of emotions lacked integration of theory. Measurements of emotions mostly relied on self-reports while stress was often measured via physiological and self-report measurements. Negative emotions such as anxiety were sometimes seen as interchangeable with the term stress. No inferences were made about specific emotions of participants from their emotional intelligence. CONCLUSIONS Our scoping review illustrates that learners in simulation-based education are most often anxious and fearful. However, this is partially due to medical education prioritising measuring negative emotions. Further theoretical integration when examining emotions and stress may help broaden the scope towards other kinds of emotions and better conceptualisations of their impact. We call for simulation education researchers to reflect on how they understand emotions, and whether their understanding may neglect any specific aspect of affective experiences their simulation participants may have.
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Affiliation(s)
| | | | - Elif Bilgic
- Department of Surgery, McGill University, Montreal, Canada
- Department of Pediatrics, McMaster University, Hamilton, Canada
- McMaster Education Research Innovation and Theory (MERIT) program, Hamilton, Canada
| | - Alison Yang
- Department of Surgery, McGill University, Montreal, Canada
| | | | - Hannah Peters
- Department of Surgery, McGill University, Montreal, Canada
| | - Kexin Li
- Department of Surgery, McGill University, Montreal, Canada
| | | | - Jason M Harley
- Department of Surgery, McGill University, Montreal, Canada.
- Research Institute of the McGill University Health Centre, Montreal, Canada.
- Institute for Health Sciences Education, McGill University, Montreal, Canada.
- Steinberg Centre for Simulation and Interactive Learning, McGill University, Montreal, Canada.
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Sobczak K, Trzciński M, Kotłowska A, Lenkiewicz J, Lenkiewicz O, Przeniosło J, Plenikowski J. Delivering Bad News: Emotional Perspective and Coping Strategies of Medical Students. Psychol Res Behav Manag 2023; 16:3061-3074. [PMID: 37576446 PMCID: PMC10417753 DOI: 10.2147/prbm.s421995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/26/2023] [Indexed: 08/15/2023] Open
Abstract
Purpose The aim of our study was to analyze students' emotional experiences and coping mechanisms regarding the situation of delivering bad news (DBN). Patients and Methods 291 fifth- and sixth-year students from 14 medical universities took part in our study. Their responses were analyzed from the perspective of their experience - whether the individuals received bad news, delivered bad news themselves, witnessed bad news being delivered, or had no experience at all. We used content analysis (CA) to examine the responses and analyzed classified variables using χ2 tests, logistic regression, and predictive modeling with multiple correspondence analysis (MCA). Results Students who had experience as a deliverer were more likely to experience failure and guilt (p=0.005). Predictions of anxiety (59.3%), stress (41.9%), and sadness (33.7%) were the highest in the students with no DBN experience. These students were most likely to make statements suggesting lack of methods and strategies for coping with difficult emotions. Students, who were immersed in DBN experiences, more often expressed the need to talk about their emotions with an experienced doctor, a family member or a friend, and used those conversations as a coping strategy. Conclusion The most important aspects that influence the quality of delivering bad news are both communication skills and emotional context. Training regarding DBN should not only contain those two elements, but also consider the development of coping mechanisms.
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Affiliation(s)
- Krzysztof Sobczak
- Department of Sociology of Medicine & Social Pathology, Medical University of Gdansk, Gdansk, Poland
| | - Marcin Trzciński
- Student Scientific Circle of Medical Communication, Medical University of Gdansk, Gdańsk, Poland
| | - Agata Kotłowska
- Student Scientific Circle of Medical Communication, Medical University of Gdansk, Gdańsk, Poland
| | - Julia Lenkiewicz
- Student Scientific Circle of Medical Communication, Medical University of Gdansk, Gdańsk, Poland
| | - Oliwia Lenkiewicz
- Student Scientific Circle of Medical Communication, Medical University of Gdansk, Gdańsk, Poland
| | - Julia Przeniosło
- Student Scientific Circle of Medical Communication, Medical University of Gdansk, Gdańsk, Poland
| | - Jan Plenikowski
- Student Scientific Circle of Medical Communication, Medical University of Gdansk, Gdańsk, Poland
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Bosshard M, Schmitz FM, Guttormsen S, Nater UM, Gomez P, Berendonk C. 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. BMC Psychol 2023; 11:153. [PMID: 37165406 PMCID: PMC10173625 DOI: 10.1186/s40359-023-01167-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/14/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Breaking bad news (BBN; e.g., delivering a cancer diagnosis) is perceived as one of the most demanding communication tasks in the medical field and associated with high levels of stress. Physicians' increased stress in BBN encounters can negatively impact their communication performance, and in the long term, patient-related health outcomes. Although a growing body of literature acknowledges the stressful nature of BBN, little has been done to address this issue. Therefore, there is a need for appropriate tools to help physicians cope with their stress response, so that they can perform BBN at their best. In the present study, we implement the biopsychosocial model of challenge and threat as theoretical framework. According to this model, the balance between perceived situational demands and perceived coping resources determines whether a stressful performance situation, such as BBN, is experienced as challenge (resources > demands) or threat (resources < demands). Using two interventions, we aim to support medical students in shifting towards challenge-oriented stress responses and improved communication performance: (1) stress arousal reappraisal (SAR), which guides individuals to reinterpret their stress arousal as an adaptive and beneficial response for task performance; (2) worked examples (WE), which demonstrate how to BBN in a step-by-step manner, offering structure and promoting skill acquisition. METHODS In a randomized controlled trial with a 2 (SAR vs. control) x 2 (WE vs. control) between-subjects design, we will determine the effects of both interventions on stress response and BBN skills performance in N = 200 third-year medical students during a simulated BBN encounter. To identify students' stress responses, we will assess their perceived coping resources and task demands, record their cardiovascular activity, and measure salivary parameters before, during, and after BBN encounters. Three trained raters will independently score students' BBN skills performances. DISCUSSION Findings will provide unique insights into the psychophysiology of medical students who are tasked with BBN. Parameters can be understood more comprehensively from the challenge and threat perspective and linked to performance outcomes. If proven effective, the evaluated interventions could be incorporated into the curriculum of medical students and facilitate BBN skills acquisition. TRIAL REGISTRATION ClinicalTrials.gov (NCT05037318), September 8, 2021.
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Affiliation(s)
- Michel Bosshard
- Institute for Medical Education, University of Bern, Bern, Switzerland.
| | | | - Sissel Guttormsen
- Institute for Medical Education, University of Bern, Bern, Switzerland
| | - Urs Markus Nater
- Department of Clinical and Health Psychology, University of Vienna, Vienna, Austria
- University Research Platform "Stress of life (SOLE) - Processes and Mechanisms underlying Everyday Life Stress", University of Vienna, Vienna, Austria
| | - Patrick Gomez
- Center for Primary Care and Public Health (Unisanté), Department of Occupational and Environmental Health, University of Lausanne, Lausanne, Switzerland
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Francis L, Robertson N. Healthcare practitioners' experiences of breaking bad news: A critical interpretative meta synthesis. PATIENT EDUCATION AND COUNSELING 2023; 107:107574. [PMID: 36459829 DOI: 10.1016/j.pec.2022.107574] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/13/2022] [Accepted: 11/18/2022] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To provide an overview of healthcare practitioners' experiences of breaking bad news. METHOD Interpretative meta synthesis of 14 qualitative papers identified through a systematic search. Data were extracted and constructs elicited via reciprocal translational analysis. RESULTS Findings comprised four inter-connected themes: (1) Discomfort, particularly difficult emotional and physical responses to breaking bad news; (2) Relational distress, connected to attachment and identification with patients; (3) Inadequate clinician, indicating the fear and rumination about the possibility of getting it wrong and the subsequent self-blame; and (4) Only human, highlighting a culture of invulnerability where practitioner self-care is deprioritised. CONCLUSIONS Breaking bad news provokes significant distress for practitioners, particularly where they experience strong attachment to or identification with a patient. Breaking bad news was understood as an isolating experience and staff's non-disclosure of difficulties appeared to sustain a culture of invulnerability in which admission of distress was not encouraged. PRACTICE IMPLICATIONS Given the adverse impacts and potential for practitioner burnout, organisations should acknowledge ramifications and offer time for staff to process the delivery of bad news, promote a culture of collective care and provide space for reflective practice.
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Affiliation(s)
- Laura Francis
- School of Psychology and Vision Sciences, University of Leicester, George Davies Centre, Lancaster Road, Leicester LE1 7HA, UK.
| | - Noelle Robertson
- School of Psychology and Vision Sciences, University of Leicester, George Davies Centre, Lancaster Road, Leicester LE1 7HA, UK.
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Das Gupta S, Faber H, Kistemaker D, Bobbert M. The elevated metabolic cost of walking at preferred speeds of healthy elderly on treadmills compared to overground is not related to increased self-reported anxiety. Eur J Appl Physiol 2023; 123:1135-1143. [PMID: 36658432 PMCID: PMC10119260 DOI: 10.1007/s00421-023-05138-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 01/09/2023] [Indexed: 01/21/2023]
Abstract
PURPOSE To investigate whether the elevation in metabolic cost of walking on treadmills compared to overground for healthy elderly is related to self-reported anxiety and if changes in self-reported anxiety are related to changes in heart rate. METHODS We measured overground preferred walking speed, oxygen consumption rate and heart rates during rest and walking, and self-reported anxiety in 10 elderly (mean age 69.5 ± 3.1 years, 8 males and 2 females). At their preferred speed, the participants first walked overground, then on a high treadmill, and then on a low treadmill. Gross and Net metabolic costs of walking were calculated from the rates of oxygen consumption. RESULTS Gross and net metabolic cost of walking were higher (p < 0.05) on high treadmill (net cost: 2.64 J kg-1 m-1) and low treadmill (net cost: 2.68 J kg-1 m-1) compared to overground (net cost: 2.44 J kg-1 m-1), and the same was true for heart rate. There were no significant differences (p > 0.05) in metabolic costs and heart rates between the two treadmill conditions. Self-reported anxiety was higher on the high treadmill compared to overground (p = 0.004) and compared to low treadmill (p = 0.02). We found no significant difference (p > 0.05) for self-reported anxiety between overground and the low treadmill. CONCLUSION These results show that treadmill walking cannot be adequately generalized to overground walking. The differences found in metabolic cost on treadmills compared to overground were not related to differences in self-reported anxiety. Furthermore, the changes in heart rate are not related to changes in self-reported anxiety.
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Affiliation(s)
- Sauvik Das Gupta
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Human Movement Biomechanics Research Group, Department of Movement Sciences, Biomedical Sciences Group, KU Leuven, Leuven, Belgium
| | - Herre Faber
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Faculty of Health, Nutrition and Sports, The Hague University for Professional Education, The Hague, The Netherlands
| | - Dinant Kistemaker
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Maarten Bobbert
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Post B, Badea C, Faisal A, Brett SJ. Breaking bad news in the era of artificial intelligence and algorithmic medicine: an exploration of disclosure and its ethical justification using the hedonic calculus. AI AND ETHICS 2022; 3:1-14. [PMID: 36338525 PMCID: PMC9628590 DOI: 10.1007/s43681-022-00230-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/12/2022] [Indexed: 11/05/2022]
Abstract
An appropriate ethical framework around the use of Artificial Intelligence (AI) in healthcare has become a key desirable with the increasingly widespread deployment of this technology. Advances in AI hold the promise of improving the precision of outcome prediction at the level of the individual. However, the addition of these technologies to patient-clinician interactions, as with any complex human interaction, has potential pitfalls. While physicians have always had to carefully consider the ethical background and implications of their actions, detailed deliberations around fast-moving technological progress may not have kept up. We use a common but key challenge in healthcare interactions, the disclosure of bad news (likely imminent death), to illustrate how the philosophical framework of the 'Felicific Calculus' developed in the eighteenth century by Jeremy Bentham, may have a timely quasi-quantitative application in the age of AI. We show how this ethical algorithm can be used to assess, across seven mutually exclusive and exhaustive domains, whether an AI-supported action can be morally justified.
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Affiliation(s)
- Benjamin Post
- Department of Bioengineering, Imperial College London, London, UK
- Department of Computing, Imperial College London, London, UK
- UKRI Centre in AI for Healthcare, Imperial College London, London, UK
| | - Cosmin Badea
- Department of Computing, Imperial College London, London, UK
| | - Aldo Faisal
- Department of Bioengineering, Imperial College London, London, UK
- Department of Computing, Imperial College London, London, UK
- UKRI Centre in AI for Healthcare, Imperial College London, London, UK
- Institute of Artificial and Human Intelligence, University of Bayreuth, Bayreuth, Germany
| | - Stephen J. Brett
- UKRI Centre in AI for Healthcare, Imperial College London, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
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Herrmann-Werner A, Erschens R, Fries M, Wehner H, Zipfel S, Festl-Wietek T. The effects of diverse fidelity scenarios on stress in medical students when taking patients' medical histories: A longitudinal study. Stress Health 2022. [PMID: 36288563 DOI: 10.1002/smi.3206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 10/14/2022] [Accepted: 10/18/2022] [Indexed: 11/09/2022]
Abstract
Taking patients' medical history correctly is the basis of diagnosis and therapy. Medical students as a vulnerable group may perceive patient-physician interactions as stressful. This study examines stress among medical students in different degrees of fidelity when taking a patient's medical history. In this longitudinal study, students' stress levels were assessed during scenarios with different degrees of fidelity (role-play, simulated patient encounters and real patient encounters) using standardised questionnaires (State-Trait Anxiety Inventory and a distress scale) and the physiological measurement of heart rate variability. The stress level of participating medical students (N = 128) was expected to significantly increase during scenarios of increasing fidelity (Mroleplay = 2.08 ± 0.92; SPEs: Msimulatedpatient = 2.68 ± 1.08; RPEs: Mrealpatient = 3.35 ± 1.08; p < 0.001). Whereas physiological stress was significantly higher with real patients (N = 106), psychological stress was not affected by the fidelity of the scenarios (N = 85). Medical students experienced stress when taking patients' medical history. Medical students might be unaware of their perceived stress based on the results. Thus, they should know how to cope with stress in such situations.
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Affiliation(s)
- Anne Herrmann-Werner
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital Tuebingen, Internal Medicine, Tuebingen, Germany.,TIME-Tuebingen Insitute for Medical Education, University of Tuebingen, Tuebingen, Germany
| | - Rebecca Erschens
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital Tuebingen, Internal Medicine, Tuebingen, Germany
| | - Maximilian Fries
- Department of Neurology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Hannah Wehner
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital Tuebingen, Internal Medicine, Tuebingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital Tuebingen, Internal Medicine, Tuebingen, Germany.,Deanery of Students' Affairs, Faculty of Medicine Eberhard-Karls University Tuebingen, Tuebingen, Germany
| | - Teresa Festl-Wietek
- TIME-Tuebingen Insitute for Medical Education, University of Tuebingen, Tuebingen, Germany
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11
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Isaksson J, Krabbe J, Ramklint M. Medical students' experiences of working with simulated patients in challenging communication training. ADVANCES IN SIMULATION (LONDON, ENGLAND) 2022; 7:32. [PMID: 36217210 PMCID: PMC9552443 DOI: 10.1186/s41077-022-00230-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/24/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Physicians' communication skills are important for patient-centered care. Although working with simulated patients (SPs) in case simulations is common for training communication skills, studies seldom include a wide range of challenging behaviors or explore students' own experiences of learning communication skills with SPs. Therefore, this study was aimed at investigating how medical students perceive communication training involving challenging consultations with SPs and the impact on their learning experiences. METHODS Twenty-three medical students from the same class were interviewed in focus groups about their experiences of simulation training with actors as SPs. In the simulation training, the students were instructed to deliver bad news, manage negative patient reactions, and encourage behavioral changes in reluctant patients. This was followed by feedback and a debriefing exercise. The interviews were analyzed with content analysis. RESULTS Students reported that actors as SPs made the simulations more realistic and enabled them to practice various communication skills for challenging consultations in a safe way and manage their own feelings, thereby promoting new learning experiences. Elements such as actors' flexibility in changing behaviors during role-play and exposure to different challenging behaviors, like negative emotions, were regarded as valuable. The importance of an accepting and permissive climate for the debriefing exercise was highlighted, though without taking too much time from the simulation training. Feedback directly from the SP was appreciated. CONCLUSIONS Actors as SPs were perceived as a valuable part of challenging communication training and added elements to the learning process. Future studies should include a wider range of challenging behaviors in training with SPs and evaluate the effects of such training on students' use of communication skills.
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Affiliation(s)
- Johan Isaksson
- Child and Adolescent Psychiatry and Psychiatry Unit, Department of Medical Sciences, Uppsala University, Uppsala, Sweden. .,Department of Women's and Children's Health, Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.
| | - Julia Krabbe
- Child and Adolescent Psychiatry and Psychiatry Unit, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Mia Ramklint
- Child and Adolescent Psychiatry and Psychiatry Unit, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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12
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Kotłowska A, Przeniosło J, Sobczak K, Plenikowski J, Trzciński M, Lenkiewicz O, Lenkiewicz J. Influence of Personal Experiences of Medical Students on Their Assessment of Delivering Bad News. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12040. [PMID: 36231342 PMCID: PMC9565137 DOI: 10.3390/ijerph191912040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/16/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND We aimed to identify which attitudes and emotions accompany latter-year medical students as they experience situations where bad news is communicated. METHODS A cross-sectional study was conducted using the computer-assisted web interview (CAWI) methodology in a group of 321 fifth- and sixth-year medical students from 14 medical universities in Poland. Correlations were analyzed using Pearson's χ2 test. For the categorical variables, subject profiles were analyzed using K-means clustering. RESULTS Students' self-assessments of their competence in delivering bad news (DBN) differed depending on the type of experience they had with it. More than half of the students had observed a situation of DBN (63.6%) and as many as 26.5% of the participants had received bad news themselves. These two groups were less likely to declare a lack of DBN-related skills (43.4% and 33.4%, respectively) than others. In this study, 9% of the students had personally delivered bad news. Only 13.4% of these students rated their DBN skills as insufficient. They were also the least likely to express concern regarding high levels of stress (29.6%) and anxiety (48%). CONCLUSIONS The ability to personally deliver bad medical news to a patient was the most effective form of gaining experience in DBN. Being a bearer of bad news may help students develop their own strategies for coping with difficult emotions and develop their professional competences, leading to improved medical care and patient comfort.
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Affiliation(s)
- Agata Kotłowska
- Faculty of Medicine, Student Scientific Circle of Medical Communication at the Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Julia Przeniosło
- Faculty of Medicine, Student Scientific Circle of Medical Communication at the Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Krzysztof Sobczak
- Department of Sociology of Medicine and Social Pathology, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Jan Plenikowski
- Faculty of Medicine, Student Scientific Circle of Medical Communication at the Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Marcin Trzciński
- Faculty of Medicine, Student Scientific Circle of Medical Communication at the Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Oliwia Lenkiewicz
- Faculty of Medicine, Student Scientific Circle of Medical Communication at the Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Julia Lenkiewicz
- Faculty of Medicine, Student Scientific Circle of Medical Communication at the Medical University of Gdansk, 80-210 Gdansk, Poland
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13
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Libert Y, Peternelj L, Bragard I, Marchal S, Reynaert C, Slachmuylder JL, Razavi D. A randomized controlled trial assessing behavioral, cognitive, emotional and physiological changes resulting from a communication skills training in physicians caring for cancer patients. PATIENT EDUCATION AND COUNSELING 2022; 105:2888-2898. [PMID: 35787813 DOI: 10.1016/j.pec.2022.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 04/15/2022] [Accepted: 04/16/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE This randomized study assesses behavioral, cognitive, emotional and physiological changes resulting from a communication skills training (CST) for physicians caring for cancer patients. METHODS Medical specialists (N = 90) were randomly assigned in groups to complete a manualized 30-h CST or to a waiting list. Assessments included behavioral (communication skills), cognitive (self-efficacy, sense of mastery), emotional (perceived stress) and physiological (heart rate) measures. Assessments were made at baseline (both groups), after CST program (training group), and four months after (waiting list group). All assessments were conducted before, during, and after a complex communication task with an advanced-stage cancer simulated patient (SP). RESULTS Trained physicians had higher levels of communication skills (from RR=1.32; p = .003 to RR=41.33; p < .001), self-efficacy (F=9.3; p = .003), sense of mastery (F=167.9; p < .001) and heart rate during the SP encounter (from F=7.4; p = .008 to F=4; p = .050) and same levels of perceived stress (F=3.1; p = .080). CONCLUSION A learner-centered, skills-focused and practice-oriented manualized 30-h CST induced multilevel changes indicating physician engagement in a learning process. PRACTICE IMPLICATIONS Trainers should consider the CST multilevel benefits (behavioral, cognitive, emotional and physiological) before, during and after a complex communication simulated task as an innovative way to assess the efficacy of a communication skills learning process.
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Affiliation(s)
- Yves Libert
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Brussels, Belgium; Institut Jules Bordet, Clinique de Psycho-Oncologie, Université Libre de Bruxelles, Brussels, Belgium.
| | - Livia Peternelj
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Brussels, Belgium
| | - Isabelle Bragard
- Université de Liège, Faculté des Sciences Psychologiques et de l'Éducation, Liège, Belgium
| | | | - Christine Reynaert
- Université Catholique de Louvain, Faculté de Médecine, Brussels, Belgium
| | | | - Darius Razavi
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Brussels, Belgium; Institut Jules Bordet, Clinique de Psycho-Oncologie, Université Libre de Bruxelles, Brussels, Belgium
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14
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Brogaard L, Hvidman L, Esberg G, Finer N, Hjorth-Hansen KR, Manser T, Kierkegaard O, Uldbjerg N, Henriksen TB. Teamwork and Adherence to Guideline on Newborn Resuscitation-Video Review of Neonatal Interdisciplinary Teams. Front Pediatr 2022; 10:828297. [PMID: 35265565 PMCID: PMC8900704 DOI: 10.3389/fped.2022.828297] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/12/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Little is known about the importance of non-technical skills for the adherence to guidelines, when teams of midwives, obstetricians, anesthesiologists, and pediatricians resuscitate and support the transition of newborns. Non-technical skills are competences underpinning successful teamwork in healthcare. These are usually referred to as leadership, situational awareness, communication, teamwork, decision making, and coping with stress and fatigue. OBJECTIVE By review of videos of teams managing newborns with difficult transition, we aimed to investigate whether the level of the teams' non-technical skills was associated with the degree of adherence to guidelines for newborn resuscitation and transitional support at birth. METHODS Four expert raters independently assessed 43 real-life videos of teams managing newborns with transitional difficulties, two assessed the non-technical score and two assessed the clinical performance. Exposure was the non-technical score, obtained by the Global Assessment Of Team Performance checklist (GAOTP). GAOTP was rated on a Likert Scale 1-5 (1 = poor, 3 = average and 5 = excellent). The outcome was the clinical performance score of the team assessed according to adherence of the European Resuscitation Counsel (ERC) guideline for neonatal resuscitation and transitional support. The ERC guideline was adapted into the checklist TeamOBS-Newborn to facilitate a structured and simple performance assessment (low score 0-60, average 60-84, high 85-100). Interrater agreement was analyzed by intraclass correlation (ICC), Bland-Altman analysis, and Cohen's kappa weighted. The risk of high and low clinical performance was analyzed on the logit scale to meet the assumptions of normality and constant standard deviation. RESULTS Teams with an excellent non-technical score had a relative risk 5.5 [95% confidence interval (CI) 2.4-22.5] of high clinical performance score compared to teams with average non-technical score. In addition, we found a dose response like association. The specific non-technical skills associated with the highest degree of adherence to guidelines were leadership and teamwork, coping with stress and fatigue, and communication with parents. Inter-rater agreement was high; raters assessing non-technical skills had an interclass coefficient (ICC) 0.88 (95% CI 0.79-0.94); the neonatologists assessing clinical performance had an ICC of 0.81 (95% CI 0.66-0.89). CONCLUSION Teams with an excellent non-technical score had five times the chance of high clinical performance compared to teams with average non-technical skills. High performance teams were characterized by good leadership and teamwork, coping with stress, and fatigue and communication with parents.
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Affiliation(s)
- Lise Brogaard
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lone Hvidman
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Gitte Esberg
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Neil Finer
- Department of Neonatology, University of California, San Diego, San Diego, CA, United States
| | | | - Tanja Manser
- School of Applied Psychology, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
| | - Ole Kierkegaard
- Department of Obstetrics and Gynecology, Horsens Regional Hospital, Horsens, Denmark
| | - Niels Uldbjerg
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Tine B Henriksen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
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15
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van Winden D, van Rijn RM, Savelsbergh GJP, Oudejans RRD, Stubbe JH. The Association Between Stress and Injury: A Prospective Cohort Study Among 186 First-Year Contemporary Dance Students. Front Psychol 2021; 12:770494. [PMID: 34803856 PMCID: PMC8602075 DOI: 10.3389/fpsyg.2021.770494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/15/2021] [Indexed: 11/13/2022] Open
Abstract
The demanding environment that contemporary dance students are exposed to could result in high stress levels, which can influence injury susceptibility. Therefore, this study aims to investigate the association between stress and injuries. In the period between September 2016 and March 2020, four cohorts of first-year dance students (N = 186; mean age 19.21 ± 1.35 years) were followed for one academic year. Each month, general stress was assessed on a 0-100 visual analogous scale. The Oslo Sports Trauma Research Center Questionnaire on Health Problems was used on a monthly basis to monitor injuries. Injuries were defined as "all injuries" (i.e., any physical complaint irrespective of the need for medical attention or time-loss from dance) and "substantial injuries" (i.e., leading to moderate/severe/complete reductions in training volume or performance). Mann-Whitney tests were performed to measure differences in general stress levels between injured and injury-free students, while repeated-measures ANOVA were performed to investigate whether general stress scores increased before and during injury occurrence. The overall average monthly general stress score over all cohorts for all students was 39.81. The monthly general stress scores ranged from 31.75 to 49.16. Overall, injured and substantially injured students reported higher stress scores than injury-free students, with significant differences in 3 out of the 9 months for all injuries (September, October, March, p < 0.05), and in 5 months for substantial injuries (September, October, November, December, April, p < 0.05). Within the 3-month period before and during injury occurrence, a (marginally) significant linear effect of general stress across the time periods was found for all injuries [F(1.87,216.49) = 3.10, p = 0.051] and substantial injuries [F(2,138) = 4.16, p = 0.018]. The results indicate an association between general stress and injuries. Future research should focus on effects of varying stress levels on injury risk using higher sampling frequency, for instance by measuring weekly since stress levels are likely to fluctuate daily. Practically, strategies aiming at stress reduction might have the potential to reduce the burden of dance injuries and may have positive outcomes for dancers, teachers, schools, and companies.
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Affiliation(s)
- Diana van Winden
- Codarts Rotterdam, University of the Arts, Rotterdam, Netherlands.,Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands.,PErforming Artist and Athlete Research Lab (PEARL), Rotterdam, Netherlands
| | - Rogier M van Rijn
- Codarts Rotterdam, University of the Arts, Rotterdam, Netherlands.,PErforming Artist and Athlete Research Lab (PEARL), Rotterdam, Netherlands
| | - Geert J P Savelsbergh
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands.,Institute of Brain and Behavior, Amsterdam, Netherlands.,Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Raôul R D Oudejans
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands.,Institute of Brain and Behavior, Amsterdam, Netherlands.,Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Janine H Stubbe
- Codarts Rotterdam, University of the Arts, Rotterdam, Netherlands.,PErforming Artist and Athlete Research Lab (PEARL), Rotterdam, Netherlands.,Rotterdam Arts and Sciences Lab (RASL), Rotterdam, Netherlands.,Department of General Practice, Erasmus University Medical Center, Rotterdam, Netherlands
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16
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Dale MacLaine T, Lowe N, Dale J. The use of simulation in medical student education on the topic of breaking bad news: A systematic review. PATIENT EDUCATION AND COUNSELING 2021; 104:2670-2681. [PMID: 33926808 DOI: 10.1016/j.pec.2021.04.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Simulated patients (SPs) are widely used, but the most effective way of utilising them in undergraduate breaking bad news (BBN) medical education is unknown. OBJECTIVES To conduct a systematic review into SP's use in developing BBN skills in medical students. METHODS 14 databases searched with the terms "Medical education", "Patient simulation", "Bad news". Data was systematically extracted, and thematic analysis undertaken. RESULTS Of 2117 articles screened, 29 publications met the inclusion criteria. These demonstrated a variety of SP models, including actors as patients (65.5%), peers (7.0%), and cancer survivors (3.5%). with delivery at varying times in the curricula. SPs are uniformly reported as having positive impact, but there is a lack of high-quality evidence comparing the use of differing forms of training. There was some evidence that virtual SPs were as useful as in-person SPs. CONCLUSIONS SPs allow students to practise vital BBN communication skills without risking detriment to patient care. Despite the heterogeneity of ways in which SPs have been used, the benefits of different approaches and when and how these should be delivered remains unclear. PRACTICE IMPLICATIONS Further educational development and research is needed about the use of SPs to support undergraduate BBN communication skills development.
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Affiliation(s)
| | - Nicholas Lowe
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Jeremy Dale
- Warwick Medical School, University of Warwick, Coventry, UK.
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17
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Rexhepi H, Moll J, Huvila I, Åhlfeldt RM. Do you want to receive bad news through your patient accessible electronic health record? A national survey on receiving bad news in an era of digital health. Health Informatics J 2021; 27:14604582211035817. [PMID: 34461772 DOI: 10.1177/14604582211035817] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Despite the fact that patient accessible electronic health records (PAEHRs) have been around for many years in several countries, there is a lack of research investigating patient's preferences for receiving bad news, including through PAEHRs. Little is also known about the characteristics of the patients who prefer to receive bad news through the PAEHR in terms of, for example medical diagnosis, age and educational level. This study, based on a national patient survey in Sweden (N = 2587), investigated this. Results show that, generally, receiving bad news by reading in the PAEHR is still among the least preferred options. Additionally, a higher proportion of men want to receive bad news in the PAEHR compared to women (p = 0.001), and the same goes for those who are not working/have worked in healthcare (p = 0.007). An effect of disease groups was also found, showing that diabetes patients in particular, want to receive bad news through the PAEHR.
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Affiliation(s)
| | - Jonas Moll
- Örebro University School of Business, Sweden
| | - Isto Huvila
- Uppsala University, Sweden.,Åbo Akademi University, Finland
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18
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Anuk D, Alçalar N, Sağlam EK, Bahadır G. Breaking bad news to cancer patients and their families: Attitudes toward death among Turkish physicians and their communication styles. J Psychosoc Oncol 2021; 40:115-130. [PMID: 34445939 DOI: 10.1080/07347332.2021.1969488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
To investigate how Turkish oncologists' attitudes toward death influence their emotional states, outlooks, and communication styles when breaking bad news to cancer patients and/or their families. Cross-sectional study using self-completed questionnaires. The study sample consisted of 35 physicians working at an oncology department. Physicians completed a quantitative one-time survey developed by the authors and the Death Attitude Profile-Revised (DAP-R). Thirty-one physicians completed the survey and the DAP-R. A mean of 13.39 ± 8.82 minutes was allocated for breaking bad news; 87.1% of the participants avoided using the word "cancer" and 42% avoided using the word "death". The attitudes characterized by "death avoidance" and "fear of death" were found to be related to the emotional difficulty experienced by the physicians, and were also associated with less eye contact with the patient, and less attention paid to the language used while breaking bad news. It is important for physicians to be aware of how their attitudes toward death affect their communication with patients during bad news. They should be provided in-service professional education, and therapeutic support.
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Affiliation(s)
- Dilek Anuk
- Istanbul Faculty of Medicine, Department of Psychiatry, Consultation Liaison Division, Istanbul University, Istanbul, Turkey
| | - Nilüfer Alçalar
- Istanbul Faculty of Medicine, Department of Psychiatry, Consultation Liaison Division, Istanbul University, Istanbul, Turkey
| | - Esra Kaytan Sağlam
- Radiation Oncology Division Capa, Istanbul University Oncology Institute, Istanbul, Turkey
| | - Güler Bahadır
- Istanbul Faculty of Medicine, Department of Psychiatry, Istanbul University, Istanbul, Turkey
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19
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Rexhepi H, Huvila I, Åhlfeldt RM, Cajander Å. Cancer patients' information seeking behavior related to online electronic healthcare records. Health Informatics J 2021; 27:14604582211024708. [PMID: 34296650 DOI: 10.1177/14604582211024708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patients' online access to their EHR together with the rapid proliferation of medical information on the Internet has changed how patients use information to learn about their health. Patients' tendency to turn to the Internet to find information about their health and care is well-documented. However, little is known about patients' information seeking behavior when using online EHRs. By using information horizons as an analytical tool this paper aims to investigate the information behavior of cancer patients who have chosen to view their EHRs (readers) and to those who have not made that option (non-readers). Thirty interviews were conducted with patients. Based on information horizons, it seems that non-reading is associated with living in a narrower information world in comparison to readers. The findings do not suggest that the smallness would be a result of active avoidance of information, or that it would be counterproductive for the patients. The findings suggest, however, that EHRs would benefit from comprehensive linking to authoritative health information sources to help users to understand their contents. In parallel, healthcare professionals should be more aware of their personal role as a key source of health information to those who choose not to read their EHRs.
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Affiliation(s)
| | - Isto Huvila
- Uppsala University, Sweden.,Åbo Akademi University, Finland
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20
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Jacklin S, Maskrey N, Chapman S. Shared Decision-Making With a Virtual Patient in Medical Education: Mixed Methods Evaluation Study. JMIR MEDICAL EDUCATION 2021; 7:e22745. [PMID: 34110299 PMCID: PMC8235293 DOI: 10.2196/22745] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 02/11/2021] [Accepted: 04/17/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Shared decision-making (SDM) is a process in which clinicians and patients work together to select tests, treatments, management, or support packages based on clinical evidence and the patient's informed preferences. Similar to any skill, SDM requires practice to improve. Virtual patients (VPs) are simulations that allow one to practice a variety of clinical skills, including communication. VPs can be used to help professionals and students practice communication skills required to engage in SDM; however, this specific focus has not received much attention within the literature. A multiple-choice VP was developed to allow students the opportunity to practice SDM. To interact with the VP, users chose what they wanted to say to the VP by choosing from multiple predefined options, rather than typing in what they wanted to say. OBJECTIVE This study aims to evaluate a VP workshop for medical students aimed at developing the communication skills required for SDM. METHODS Preintervention and postintervention questionnaires were administered, followed by semistructured interviews. The questionnaires provided cohort-level data on the participants' views of the VP and helped to inform the interview guide; the interviews were used to explore some of the data from the questionnaire in more depth, including the participants' experience of using the VP. RESULTS The interviews and questionnaires suggested that the VP was enjoyable and easy to use. When the participants were asked to rank their priorities in both pre- and post-VP consultations, there was a change in the rank position of respecting patient choices, with the median rank changing from second to first. Owing to the small sample size, this was not analyzed for statistical significance. The VP allowed the participants to explore a consultation in a way that they could not with simulated or real patients, which may be part of the reason that the VP was suggested as a useful intervention for bridging from the early, theory-focused years of the curriculum to the more patient-focused ones later. CONCLUSIONS The VP was well accepted by the participants. The multiple-choice system of interaction was reported to be both useful and restrictive. Future work should look at further developing the mode of interaction and explore whether the VP results in any changes in observed behavior or practice.
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Affiliation(s)
- Simon Jacklin
- School of Pharmacy and Bioengineering, Keele University, Keele, United Kingdom
| | - Neal Maskrey
- School of Pharmacy and Bioengineering, Keele University, Keele, United Kingdom
| | - Stephen Chapman
- School of Pharmacy and Bioengineering, Keele University, Keele, United Kingdom
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21
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Leoniuk K, Sobczak K. Unfavorable Medical Diagnosis - Oncological Patients' Experiences and Preferences. HEALTH COMMUNICATION 2021; 36:433-439. [PMID: 31749389 DOI: 10.1080/10410236.2019.1693131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The study aims at analyzing the experiences of Polish patients who received an unfavorable medical diagnosis. In order to reach a random group of patients with an unfavorable diagnosis, we started cooperating with 19 independent patient organizations and associations. A nationwide study, based on a self-constructed e-survey questionnaire, was carried out with the use of the CAWI method. Three hundred and fourteen patients in total participated in the study, all of whom had received an unfavorable diagnosis, including 119 oncological patients and 195 suffering from other chronic diseases. This paper focuses on the analysis of the opinions expressed by oncological patients. It also highlights the differences in oncological and non-oncological patients' reactions to an unfavorable diagnosis. Caution and tactfulness displayed by a physician while conveying an unfavorable diagnosis were assessed negatively by 36% of the respondents, 8 in 10 oncological patients claim that Polish doctors are insufficiently prepared to communicate bad news. As far as the model of the physician-patient relationship is concerned, over half of the surveyed (59%) prefers partnership, 18% opts for an informative model, 16% chooses a model based on dialogue and empathy and 7% is in favor of a paternalistic model. We have demonstrated that the very location where diagnosis is conveyed affects the quality of medical communication: patients visiting a private doctor's office have a better chance to express their doubts than the ones treated at a hospital or a public outpatient clinic. The majority of oncological patients, especially individuals under the age of 40, prefer shared decision-making.
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Affiliation(s)
- Katarzyna Leoniuk
- Department of Social Medicine and Social Pathology, Medical University of Gdansk
| | - Krzysztof Sobczak
- Department of Social Medicine and Social Pathology, Medical University of Gdansk
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22
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Gold R, Gold A. The experience of speech-language therapists and audiologists when delivering bad news: A qualitative analysis. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2021; 56:402-414. [PMID: 33682224 DOI: 10.1111/1460-6984.12612] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/10/2021] [Accepted: 02/12/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND As part of their professional responsibilities, speech-language therapists and audiologists are required to deliver bad news. AIMS The aim of this qualitative study is to describe and characterize the subjective experience of speech-language therapists and audiologists when delivering bad news to clients or their family members. METHODS & PROCEDURES A group of 156 speech-language therapists and audiologists replied in writing to an open question asking them to describe a clinical encounter in which they delivered bad news. The texts that were generated in response to this question served as a data base. Qualitative content analysis was used to analyse data and generate themes. OUTCOMES & RESULTS Thematic analysis of participants' texts revealed the challenges inherent to the delivery of bad news. Four main themes emerged from text analysis: difficulty in phrasing the news; the deliverer's emotional experience; the receiver's reaction; and being alone or in companion with another healthcare provider during the delivery of the bad news. CONCLUSIONS & IMPLICATIONS Speech-language therapists and audiologists experience difficulties similar to those experienced by other healthcare professionals when delivering bad news. Nevertheless, speech-language therapists and audiologists seem to perceive the delivery of bad news situation in a broader sense than the conventional definition given to this term in the medical arena. What this paper adds What is already known on the subject The task of delivering bad news is stressful to healthcare professionals. Most of the literature on the topic pertains to physicians. Little is known regarding the delivery of bad news in speech-language therapy and audiology. What this paper adds to existing knowledge This study highlights the challenges that speech-language therapists and audiologists encounter when delivering bad news. Furthermore, it illuminates the implicit perceptions of these professionals regarding what is considered 'bad news'. What are the potential or actual clinical implications of this work? The emotional challenges associated with the delivery of bad news underscore the importance of support and training regarding the delivery of bad news. It is especially important to prepare for a client's difficult questions, and to prefer a collaborative approach to the delivery of bad news.
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Affiliation(s)
- Rinat Gold
- Department of Communication Disorders, Tel-Aviv University, Tel-Aviv, Israel
| | - Azgad Gold
- Forensic Psychiatry Unit, Beer Yaakov Mental Health Center, Beer Yaakov, Israel
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Akbari AR, Alam B, Ageed A. Response to 'Final-year pharmacy and medical students do not recognise 'red flags' in childhood fever'. Acta Paediatr 2020; 109:2824. [PMID: 32583889 DOI: 10.1111/apa.15445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/16/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Amir Reza Akbari
- Faculty of Medical and Human Sciences University of Manchester Manchester UK
| | - Benyamin Alam
- Faculty of Medical and Human Sciences University of Manchester Manchester UK
| | - Ahmed Ageed
- Faculty of Medical and Human Sciences University of Manchester Manchester UK
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Kawamura A, Harris I, Thomas K, Mema B, Mylopoulos M. Exploring How Pediatric Residents Develop Adaptive Expertise in Communication: The Importance of "Shifts" in Understanding Patient and Family Perspectives. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:1066-1072. [PMID: 31464732 DOI: 10.1097/acm.0000000000002963] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE Communication with patients and families can be complex, especially in challenging discussions. To communicate effectively, expert physicians must often use flexible approaches. This innovative use of knowledge to handle complexity is an essential capability of adaptive expertise. Despite its importance for effective communication and implications for medical education, little is known about how adaptive expertise develops in trainees. The purpose of this study was to explore how pediatric residents developed adaptive expertise in communication. METHOD A constructivist grounded theory study, using observations of physician-patient communication and semistructured interviews as data sources and purposeful sampling of 10 pediatric subspecialty residents at the University of Toronto, was conducted in 2016-2017. Data collection and analysis occurred iteratively, and themes were identified through the research team's constant comparative analysis. RESULTS Residents navigated challenging discussions with patients and families by enabling them to express their own narratives and integrating these with their medical knowledge to provide care. At times, a "shift" in the residents' understanding of the families' perspectives was needed to effectively navigate the discussion. Residents used this shift purposefully to create new communication strategies, resulting in an opportunity for learning. CONCLUSIONS "Shifts" are defined as adjustments in the resident's understanding of a family's perspective that affect clinical care. Analysis suggests that these "shifts" can be understood to support development of adaptive expertise. The workplace learning environment promoted this development by providing opportunities that prepared residents for future learning through active experimentation, offering multiple perspectives and enhancing deeper conceptual learning.
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Affiliation(s)
- Anne Kawamura
- A. Kawamura is associate professor, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada. I. Harris is professor, Department of Medical Education, University of Illinois at Chicago, Chicago, Illinois. K. Thomas is a resident, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada. B. Mema is associate professor, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada. M. Mylopoulos is associate professor, Department of Pediatrics, University of Toronto, Faculty of Medicine, and scientist, Wilson Centre for Research in Education, University of Toronto, Toronto, Ontario, Canada
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Yu J, Lee S, Kim M, Lee J, Park I. Changes in Medical Students' Self-Assessments of Clinical Communication Skills after Clinical Practice and Standardized Patient Feedback. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2020; 44:272-276. [PMID: 31863413 DOI: 10.1007/s40596-019-01171-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 12/11/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE In this study, the authors aimed to analyze the effects of clinical practice and Standardized Patient (SP) feedback on medical students' self-assessments of their clinical communication skills (CCS). METHODS The authors analyzed questionnaire responses from 43 fifth-year medical students enrolled in the Ajou University School of Medicine, Suwon, Republic of Korea, in 2019, and used the Communication Assessment Tool (CAT) scale to measure the study's variables. A descriptive statistical analysis and paired t test focused on the distribution of and changes in CCS before and after clinical practice and after receiving SP feedback. RESULTS After clinical practice, the students' perceptions of their own CCS were positively increased, but after the receipt of SP feedback, they significantly decreased. Scores for the item on interpersonal relationships with the patient from the perspective of the patient were significantly lower after the SP feedback was obtained. CONCLUSIONS SP feedback emerged as an important educational method, allowing students to assess their CCS more objectively and view their CCS as physicians from the patient's perspective. SP feedback is necessary, as is providing students with the experience of receiving direct SP feedback, on clinical performance to increase patient-centered care competencies.
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Affiliation(s)
- Jihye Yu
- Ajou University School of Medicine and Graduate School of Medicine, Gyeonggi-do, Suwon-si, South Korea
| | - Sukyung Lee
- Ajou University School of Medicine and Graduate School of Medicine, Gyeonggi-do, Suwon-si, South Korea
| | - Miran Kim
- Ajou University School of Medicine and Graduate School of Medicine, Gyeonggi-do, Suwon-si, South Korea
| | - Janghoon Lee
- Ajou University School of Medicine and Graduate School of Medicine, Gyeonggi-do, Suwon-si, South Korea
| | - Inwhee Park
- Ajou University School of Medicine and Graduate School of Medicine, Gyeonggi-do, Suwon-si, South Korea.
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Hahne J, Liang T, Khoshnood K, Wang X, Li X. Breaking bad news about cancer in China: Concerns and conflicts faced by doctors deciding whether to inform patients. PATIENT EDUCATION AND COUNSELING 2020; 103:286-291. [PMID: 31455567 DOI: 10.1016/j.pec.2019.08.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 07/25/2019] [Accepted: 08/16/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES We aimed to explore how doctors in China decide whether to inform cancer patients about diagnosis and prognosis. METHODS We conducted in-depth, semi-structured interviews with 24 doctors and residents from a leading hospital in Hunan, China. Data were analyzed by content analysis. RESULTS Doctors routinely told the family about cancer first, then withheld information from patients if the family did not want to tell the patient. Three main themes emerged in relation to hiding bad news from patients: 1) fear that most patients lack resilience to cope with bad news; 2) fear of direct or legal conflict with the family, and 3) a value conflict between respecting the patient's "right to know" and respecting the family's interest in protecting the patient. CONCLUSIONS Doctors consider decisions to withhold information from cancer patients to be a non-ideal but necessary compromise of the patient's "right to know." Culturally adjusted training and guidelines could help with including the patient in information disclosure while still respecting China's cultural value of family decision-making. PRACTICE IMPLICATIONS Future training and guidelines should help doctors mediate between patient and family interests and understand changing laws and regulations. Other important elements include reflection, senior mentorship, self-awareness, and building trust.
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Affiliation(s)
- Jessica Hahne
- Yale School of Public Health, New Haven, Connecticut, USA
| | - Ting Liang
- Department of Hematology, The Third Xiangya Hospital, Central South University, Changsha 410013, PR China
| | | | - Xiaomin Wang
- Center for Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha 410013, PR China; Center for Medical Ethics, Central South University, Changsha 410013, PR China.
| | - Xin Li
- Department of Hematology, The Third Xiangya Hospital, Central South University, Changsha 410013, PR China; Center for Medical Ethics, Central South University, Changsha 410013, PR China.
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Abstract
When individuals experience empathy , they often seek to bolster others’ well-being. But what do empathizers want others to feel? Though psychologists have studied empathy and prosociality for decades, this question has yet to be clearly addressed. This is because virtually all existing research focuses on cases in which improving others’ well-being also comprises heightening their positive affect or decreasing their negative affect and helping them reach their own emotional goals. In this review, I argue that real-life empathic goals encompass a broader range—including sometimes worsening targets’ affect or contravening their wishes in order to improve their well-being—that can be productively integrated into the framework of interpersonal emotion regulation (IER). I review the empathic IER spectrum in a number of contexts, including close relationships, professional caregiving, and group-based emotions. Integrating empathy and IER provides a synthetic and generative way to ask new questions about how social emotions produce prosocial actions.
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Affiliation(s)
- Jamil Zaki
- Department of Psychology, Stanford University, Stanford, California 94305, USA
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Adelekan A, Alrashah AS, Al Hutaylah IS, Lipert A, Dibwe PM, Rasmus P. Preferred Medium of Receiving Diagnostic News Depending on Patients' Perception of Their Health Status (Healthy or Sick). Patient Prefer Adherence 2020; 14:903-915. [PMID: 32581517 PMCID: PMC7269663 DOI: 10.2147/ppa.s247726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The study aims to gain insight into people's preferred medium of receiving diagnostic news depending on their perception of their health status (either sick or healthy). METHODS Comprehensive research was carried out on two main groups of past and prospective patients, Polish respondents (N=72) and International respondents (N= 214), using a CAWI (Computer-Assisted Web Interview) technique. Respondents were asked in an online questionnaire about the past history of illness, whether they would like to receive their diagnostic news and preferred medium of receiving diagnostic news whether they perceive they are sick or healthy. RESULTS Amongst the international group, majority of respondents (143 resp. - 73.71%) would generally like to receive their diagnostic news and 156 resp. (80.83%) would prefer to receive their bad diagnostic news (BDN) from medical specialist doctors as opposed to other technological and non-technological means. Meanwhile, in the polish group, 65 resp. (90.28%) would like to generally receive their diagnostic news and 66 resp. (91.67%) would prefer to receive their BDN from medical specialist doctors as opposed to other proposed means of obtaining BDN. CONCLUSION The result of this study indicates that medical doctors, especially specialists, are still a preferred medium of receiving diagnostic news. However, a certain proportion of respondents will be open to technological medium in receiving their diagnostic news.
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Affiliation(s)
- Adediran Adelekan
- Medical University of Lodz, Department of Medical Psychology, Lodz, Poland
- Correspondence: Adediran Adelekan Medical University of Lodz, Flat 22, Narutowicza 30, Lodz90-135, PolandTel +48-729-696-726 Email
| | | | | | - Anna Lipert
- Medical University of Lodz, Department of Sport Medicine, Lodz, Poland
| | | | - Paweł Rasmus
- Medical University of Lodz, Department of Medical Psychology, Lodz, Poland
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Prieur J, Barbu S, Blois‐Heulin C, Lemasson A. The origins of gestures and language: history, current advances and proposed theories. Biol Rev Camb Philos Soc 2019; 95:531-554. [DOI: 10.1111/brv.12576] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 11/30/2019] [Accepted: 12/03/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Jacques Prieur
- Department of Education and PsychologyComparative Developmental Psychology, Freie Universität Berlin Berlin Germany
- Univ Rennes, Normandie Univ, CNRS, EthoS (Ethologie animale et humaine) – UMR 6552 F‐35380 Paimpont France
| | - Stéphanie Barbu
- Univ Rennes, Normandie Univ, CNRS, EthoS (Ethologie animale et humaine) – UMR 6552 F‐35380 Paimpont France
| | - Catherine Blois‐Heulin
- Univ Rennes, Normandie Univ, CNRS, EthoS (Ethologie animale et humaine) – UMR 6552 F‐35380 Paimpont France
| | - Alban Lemasson
- Univ Rennes, Normandie Univ, CNRS, EthoS (Ethologie animale et humaine) – UMR 6552 F‐35380 Paimpont France
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Endocrine and psychological stress response in simulated doctor-patient interactions in medical education. Psychoneuroendocrinology 2019; 105:172-177. [PMID: 30292650 DOI: 10.1016/j.psyneuen.2018.09.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 09/17/2018] [Accepted: 09/18/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Training of doctor-patient interactions by means of patient actors is considered a useful didactic tool in medical education. However, though students report it as being highly stressful little systematic research has verified this notion. AIMS To assess the endocrine and psychological stress responses of students in the doctor vs. the observer role in simulated doctor-patient interactions. METHODS Salivary cortisol and anxiety was assessed in N = 86 participants of a mandatory course on doctor-patient interactions on three consecutive days. During two of these days they were in the observer role and gave feedback to another student and on one of these days they were in the doctor role and were being given feedback. Saliva was sampled at 4 points in time per day: prior to interaction (T1); after watching the video of the interaction (T2); after feedback (T3); after observation of another interaction (T4). Assessments on observer days took place at the respective time points and at the same time of the day. 3-way mixed ANOVAs were computed with the factors "day of data sampling" (F1); "day with doctor role" (F2); "measurement time"(F3). RESULTS Significant two-way interactions F1 × F2 and three-way interactions F1 × F2 × F3 were observed both for cortisol and for anxiety (all p < .001). Neither cortisol nor anxiety were related to task severity. Anxiety at T1 correlated with cortisol increase from T1 to T2 (r = .266; p = .013). DISCUSSION Results confirm that playing the doctor role in a simulated doctor-patient interaction represents a significant stressor in medical students. Effect sizes considerably exceed those observed in laboratory stress. This brings about new questions regarding moderating factors, effects of repetitions and relationship to medical performance. The ecological validity of this stressor can also make it a useful tool in basic endocrine research.
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Collins K, Hopkins A, Shilkofski NA, Levine RB, Hernandez RG. Difficult Patient Encounters: Assessing Pediatric Residents' Communication Skills Training Needs. Cureus 2018; 10:e3340. [PMID: 30473973 PMCID: PMC6248659 DOI: 10.7759/cureus.3340] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Difficult patient encounters (DPEs) are common and can lead to frustration and dissatisfaction among healthcare providers. Pediatric resident physician experiences with DPEs and curricula for enhancing necessary communication skills have not been well described. Materials and methods We used a cross-sectional survey research design for our needs assessment on resident experiences with DPEs. Thirty-three pediatric residents completed this anonymous survey. The survey assessed residents’ experiences with and self-efficacy regarding DPEs. Descriptive statistics were used to analyze the quantitative data. Additionally, two authors independently coded free response data to include in the narrative description of the survey results. Results These survey results include the views of 92% of the residents in the program (33/36). Residents reported a greater frequency of difficult encounters in the inpatient setting than the outpatient setting. The majority of residents rated their communication skills during DPEs as “fair” or “good” (70%, 23/33). Residents tended to have lower confidence when discussing chronic pain, managing parental insistence on a plan, and breaking bad news. They generally reported higher levels of anxiety for scenarios involving angry patients and families, families insisting on a plan, and when breaking bad news. Residents cited many challenges, including working with angry and demanding families. Additionally, residents described difficulty with managing discordant opinions between the family and the healthcare team regarding the care plan. Residents expressed a preference for learning how to manage challenging patient encounters using clinical experiences. Simulation, discussion, and observation of role models also rated highly as educational methods for increasing skills, while most residents rated lectures as the least important means of training skills for these difficult encounters. Discussion We found that pediatric residents experience difficult encounters frequently, especially in the inpatient setting. Individual residents vary in their confidence and anxiety levels with different types of difficult encounters and may benefit from not only general communication skills training, but also from targeted training to equip them for the particular contexts they find most challenging. Residents value interactive structured learning activities, including discussion and simulation. Residents most consistently value the opportunity to lead challenging conversations in the clinical setting, especially when followed by effective debriefing and feedback by trained faculty preceptors. Conclusions Next steps include creating a “Difficult Encounters” communication skills curriculum informed by this needs assessment, which aim to enhance patient care as well as increase resident self-efficacy. In addition to the curriculum development for residents, it may be helpful to initiate faculty development on how to supervise resident-led difficult conversations and provide effective debriefing and feedback to promote resident growth.
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Affiliation(s)
- Kimberly Collins
- General Pediatrics, Johns Hopkins All Children's Hospital, Saint Petersburg, USA
| | - Akshata Hopkins
- General Pediatrics, Johns Hopkins All Children's Hospital, Saint Petersburg, USA
| | - Nicole A Shilkofski
- General Pediatrics, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Rachel B Levine
- Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
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Abstract
PURPOSE The aim of our research was to gain knowledge about patients' opinions, experiences, and preferences with regard to the way the news is being delivered to them. MATERIALS AND METHODS Detailed research was carried out on a group of 314 patients using the CAWI (Computer-Assisted Web Interview) technique. Adult responders who had earlier received bad news were questioned about their opinion about the way the doctor acted while delivering bad news and how he did it. RESULTS Patients, who define the following aspects of their visit as negative/lacking: 1) doctor's behavior in the moment of delivering bad news, 2) amount of time devoted to the visit, 3) lack of doctor's attention, 4) usage of medical terminology, 5) doctor's honesty, 6) emotional and cognitive support from the doctor, more often tend to change the doctor in charge of their therapy or decide to cease the medical treatment. CONCLUSION Doctors' behavior and the way they deliver news to patients are key elements that strongly influence patients' future therapy. It makes an impact on patient's decision whether to continue or cease the treatment. In the first case, it also leads the patient to choose to continue the treatment under the guidance of the same specialist or to find another one. The data that we acquired and that we will discuss below will form the basis for editing a communication protocol concerning delivering bad news. It is necessary to create such a protocol in order to improve the quality of communication with patients, especially as regards delivering bad news to them.
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Affiliation(s)
- Krzysztof Sobczak
- Department of Social Medicine and Social Pathology, Medical University of Gdansk, Gdansk, Poland,
| | - Katarzyna Leoniuk
- Department of Social Medicine and Social Pathology, Medical University of Gdansk, Gdansk, Poland,
| | - Agata Janaszczyk
- Department of Social Medicine and Social Pathology, Medical University of Gdansk, Gdansk, Poland,
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Hinkle LJ, Fettig LP, Carlos WG, Bosslet G. Twelve tips for just in time teaching of communication skills for difficult conversations in the clinical setting. MEDICAL TEACHER 2017; 39:920-925. [PMID: 28598711 DOI: 10.1080/0142159x.2017.1333587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The ability to communicate well with patients and other members of the healthcare team is a vital skill for physicians to have, but one that is often not emphasized in medical education. Learners of all levels can obtain and develop good communication skills regardless of their natural ability in this area, and the clinical setting represents an underutilized resource to accomplish this task. With this in mind, we have reviewed the growing body of literature on the subject and organized our findings into twelve tips to help educators capitalize on these missed opportunities. While our emphasis is helping learners with difficult discussions, these tips can be easily adapted to any other clinical encounter requiring clear communication. Teaching effective communication skills in the clinical setting requires some extra time, but the steps outlined should not take more than a few minutes to complete. Taking the time to develop these skills in our learners will make a significant difference not only their lives but also their patients and their families.
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Affiliation(s)
- Laura Jean Hinkle
- a Department of Medicine, Division of Pulmonary and Critical Care Medicine , Indiana University School of Medicine , Indianapolis , IN , USA
| | - Lyle Patrick Fettig
- b Department of Medicine , Indiana University School of Medicine , Indianapolis , IN , USA
| | - William Graham Carlos
- a Department of Medicine, Division of Pulmonary and Critical Care Medicine , Indiana University School of Medicine , Indianapolis , IN , USA
| | - Gabriel Bosslet
- a Department of Medicine, Division of Pulmonary and Critical Care Medicine , Indiana University School of Medicine , Indianapolis , IN , USA
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Ghazali DA, Darmian-Rafei I, Nadolny J, Sosner P, Ragot S, Oriot D. Evaluation of stress response using psychological, biological, and electrophysiological markers during immersive simulation of life threatening events in multidisciplinary teams. Aust Crit Care 2017; 31:226-233. [PMID: 28756943 DOI: 10.1016/j.aucc.2017.07.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 06/18/2017] [Accepted: 07/05/2017] [Indexed: 01/05/2023] Open
Abstract
Stress might impair clinical performance in real life and in simulation-based education (SBE). Subjective or objective measures can be used to assess stress during SBE. This monocentric study aimed to evaluate the effects of simulation of life-threatening events on measurements of various stress parameters (psychological, biological, and electrophysiological parameters) in multidisciplinary teams (MDTs) during SBE. The effect of gender and status of participants on stress response was also investigated. Twelve emergency MDTs of 4 individuals were recruited for an immersive simulation session. Stress was assessed by: (1) self-reported stress; (2) Holter analysis, including heart rate and heart rate variability in the temporal and spectral domain (autonomic nervous system); (3) salivary cortisol (hypothalamic pituitary adrenal axis). Forty-eight participants (54.2% men, <7years of experience) were included. Measures were performed at baseline (T0), after simulation (T1), after debriefing (T2), and 30min after debriefing (T3). There was an increase in stress level at T1 (p<0.001) and a decrease at T2 (p<0.001). However, the variations of stress parameters induced by simulation (T0-T1 difference and T1-T2 difference) estimated by the three approaches were not correlated, while, as expected, Holter parameters were well-correlated to each other. Immersive SBE produced a change of stress level in all MDT members with no evidence for status effect but with gender difference. None developed a PTSD. These results support the hypothesis of a complementarity of the stress paths (collective reaction with increased stress level during simulation and a decrease during debriefing) but with relative independence of these paths (lack of correlation to each other). This study also suggests that because of the lack of correlation, stress response should be assessed by a combination of psychological, biological and electrophysiological parameters.
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Affiliation(s)
- Daniel Aiham Ghazali
- Emergency Department and EMS, University Hospital of Bichat, Paris, France; Ilumens - Simulation Laboratory, University of Paris-Diderot, Paris, France; ABS Lab - Simulation Laboratory, Faculty of Medicine, University of Poitiers, France; Clinical Investigation Center CIC-INSERM1402, University Hospital of Poitiers, France.
| | - Ivan Darmian-Rafei
- Emergency Medical Service, University Hospital of Necker, Paris, France; Clinical Investigation Center CIC-INSERM1402, University Hospital of Poitiers, France
| | - Jerome Nadolny
- ABS Lab - Simulation Laboratory, Faculty of Medicine, University of Poitiers, France; Anesthesiology and Critical Care Unit, Hospital of Saintes, France; Clinical Investigation Center CIC-INSERM1402, University Hospital of Poitiers, France
| | - Philippe Sosner
- Diagnosis and Therapeutic Center, University Hospital Hôtel-Dieu, Paris, France; Clinical Investigation Center CIC-INSERM1402, University Hospital of Poitiers, France
| | - Stephanie Ragot
- Emergency Medical Service, University Hospital of Necker, Paris, France; Clinical Investigation Center CIC-INSERM1402, University Hospital of Poitiers, France
| | - Denis Oriot
- ABS Lab - Simulation Laboratory, Faculty of Medicine, University of Poitiers, France; Clinical Investigation Center CIC-INSERM1402, University Hospital of Poitiers, France; Pediatric Emergency Department, University Hospital of Poitiers, France
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Studer RK, Danuser B, Gomez P. Physicians' psychophysiological stress reaction in medical communication of bad news: A critical literature review. Int J Psychophysiol 2017; 120:14-22. [PMID: 28666771 DOI: 10.1016/j.ijpsycho.2017.06.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 06/18/2017] [Accepted: 06/26/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Stress is a common phenomenon in medical professions. Breaking bad news (BBN) is reported to be a particularly distressing activity for physicians. Traditionally, the stress experienced by physicians when BBN was assessed exclusively using self-reporting. Only recently, the field of difficult physician-patient communication has used physiological assessments to better understand physicians' stress reactions. METHOD This paper's goals are to (a) review current knowledge about the physicians' psychophysiological stress reactions in BBN situations, (b) discuss methodological aspects of these studies and (c) suggest directions for future research. RESULTS The seven studies identified all used scenarios with simulated patients but were heterogeneous with regard to other methodological aspects, such as the psychophysiological parameters, time points and durations assessed, comparative settings, and operationalisation of the communication scenarios. Despite this heterogeneity, all the papers reported increases in psychological and/or physiological activation when breaking bad news in comparison to control conditions, such as history taking or breaking good news. CONCLUSION Taken together, the studies reviewed support the hypothesis that BBN is a psychophysiologically arousing and stressful task for medical professionals. However, much remains to be done. We suggest several future directions to advance the field. These include (a) expanding and refining the conceptual framework, (b) extending assessments to include more diverse physiological parameters, (c) exploring the modulatory effects of physicians' personal characteristics (e.g. level of experience), (d) comparing simulated and real-life physician-patient encounters and (e) combining physiological assessment with a discourse analysis of physician-patient communication.
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Affiliation(s)
- Regina Katharina Studer
- Institut universitaire romand de Santé au Travail (Institute for Work and Health), University of Lausanne & University of Geneva, Route de la Corniche 2, CH-1066 Epalinges, Switzerland.
| | - Brigitta Danuser
- Institut universitaire romand de Santé au Travail (Institute for Work and Health), University of Lausanne & University of Geneva, Route de la Corniche 2, CH-1066 Epalinges, Switzerland.
| | - Patrick Gomez
- Institut universitaire romand de Santé au Travail (Institute for Work and Health), University of Lausanne & University of Geneva, Route de la Corniche 2, CH-1066 Epalinges, Switzerland.
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Choi W, Dyens O, Chan T, Schijven M, Lajoie S, Mancini ME, Dev P, Fellander-Tsai L, Ferland M, Kato P, Lau J, Montonaro M, Pineau J, Aggarwal R. Engagement and learning in simulation: recommendations of the Simnovate Engaged Learning Domain Group. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2017. [DOI: 10.1136/bmjstel-2016-000177] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundHealth professions education (HPE) is based on deliberate learning activities and clinical immersion to achieve clinical competence. Simulation is a tool that helps bridge the knowledge-to-action gap through deliberate learning. This paper considers how to optimally engage learners in simulation activities as part of HPE.MethodsThe Simnovate Engaged Learning Domain Group undertook 3 teleconferences to survey the current concepts regarding pervasive learning. Specific attention was paid to engagement in the learning process, with respect to fidelity, realism and emotions, and the use of narratives in HPE simulation.ResultsThis paper found that while many types of simulation exist, the current ways to categorise the types of simulation do not sufficiently describe what a particular simulation will entail. This paper introduces a novel framework to describe simulation by deconstructing a simulation activity into 3 core characteristics (scope, modality and environment). Then, the paper discusses how engagement is at the heart of the learning process, but remained an understudied phenomenon with respect to HPE simulation. Building on the first part, a conceptual framework for engaged learning in HPE simulation was derived, with potential use across all HPE methods.DiscussionThe framework considers how the 3 characteristics of simulation interplay with the dimensions of fidelity (physical, conceptual and emotional), and how these can be conveyed by and articulated through beauty (as a proxy for efficiency) as coexisting factors to drive learner engagement. This framework leads to the translation of deliberately taught knowledge, skills and attitudes into clinical competence and subsequent performance.
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Gemmiti M, Hamed S, Lauber-Biason A, Wildhaber J, Pharisa C, Klumb PL. Pediatricians' affective communication behavior attenuates parents' stress response during the medical interview. PATIENT EDUCATION AND COUNSELING 2017; 100:480-486. [PMID: 27816315 DOI: 10.1016/j.pec.2016.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 09/12/2016] [Accepted: 09/15/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To investigate whether the medical interview in the pediatric context generates a stressful response in parents in form of heightened cortisol activity, and whether pediatricians' empathetic communication is able to attenuate this stress response. METHODS 68 parents were recruited at pediatric out-patient and in-patient consultations. Salivary samples were collected between 60 and 30min prior to the consultation, shortly before the consultation, 20min as well as 45min after the consultation. 19 pediatricians participated in the study and effectuated the medical visit as usual. We videotaped the consultations and coded pediatricians' affective communication using the RIAS and the Four Habits Coding Scheme. RESULTS Parents' cortisol increased during the medical visit with a peak at 20min after the medical encounter. Furthermore, multilevel analysis revealed a lesser increase in parents' cortisol response associated with pediatricians' levels in supportive communication behaviors. CONCLUSION As indicated by their humoral stress responses, the medical encounter was stressful for the parents. Pediatricians' affective communication modulated this stress response in that more supportive communication was related to smaller cortisol increases. PRACTICE IMPLICATION Pediatricians' affective communication behavior during the medical visit can alleviate parents' distress and anxiety, representing a source of social and emotional support.
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Affiliation(s)
- Marco Gemmiti
- Department of Psychology, University of Fribourg, Fribourg, Switzerland.
| | - Selei Hamed
- Department of Pediatrics, Canton Hospital Fribourg, Fribourg, Switzerland
| | | | - Johannes Wildhaber
- Department of Pediatrics, Canton Hospital Fribourg, Fribourg, Switzerland
| | - Cosette Pharisa
- Department of Pediatrics, Canton Hospital Fribourg, Fribourg, Switzerland
| | - Petra L Klumb
- Department of Psychology, University of Fribourg, Fribourg, Switzerland
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Walker A, Costa BM. Transition into the workplace: comparing health graduates’ and organisational perspectives. Contemp Nurse 2016; 53:1-12. [DOI: 10.1080/10376178.2016.1254050] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Arlene Walker
- School of Psychology, Deakin University, Geelong Waterfront Campus, Locked Bag 20001, Geelong VIC 3220, Australia
| | - Beth M. Costa
- School of Psychology, Deakin University, Geelong Waterfront Campus, Locked Bag 20001, Geelong VIC 3220, Australia
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Ni YH, Alræk T. What circumstances lead to non-disclosure of cancer-related information in China? A qualitative study. Support Care Cancer 2016; 25:811-816. [PMID: 27832368 PMCID: PMC5266771 DOI: 10.1007/s00520-016-3464-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 10/26/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Withholding information from cancer patients is a common practice in many Asian countries, including China, Japan, and Singapore, as well as in some Western countries, such as Spain, Greece, and Italy. Much research has investigated why doctors withhold information from cancer patients generally, both in the West and the East, but little research has been done on specifically why Chinese doctors withhold such information. METHODS Three focus group interviews were conducted with a total of 16 oncologists in China. The interviews were recorded, transcribed, and translated. Qualitative data were analyzed using systematic text condensation. RESULTS The result of this study revealed numerous circumstances that can lead to non-disclosure of cancer-related information. Many of these circumstances have been described in previous studies about non-disclosure in other countries. We found two additional circumstances that have not been described in previous literature and might therefore expand our current knowledge about this phenomenon; they are contradiction between laws and fear for personal safety. CONCLUSION Numerous circumstances can lead to non-disclosure of cancer-related information. This study found two additional circumstances that might lead to non-disclosure. The findings of this study suggest further assessment and clarification about the laws that govern doctor-patient communication and that action should be taken to ensure safe working environments for Chinese oncologists.
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Affiliation(s)
- Yi Hu Ni
- Department of Global Public Health and Primary Care, University of Bergen, Postboks 7804, Kalfarveien 31, 5020, Bergen, Norway.
| | - Terje Alræk
- National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.,Institute of Health Sciences, Kristiania University College, PB 1190 Sentrum, 0107, Oslo, Norway
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Postma-Nilsenová M, Holt E, Heyn L, Groeneveld K, Finset A. A case study of vocal features associated with galvanic skin response to stressors in a clinical interaction. PATIENT EDUCATION AND COUNSELING 2016; 99:1349-1354. [PMID: 26988238 DOI: 10.1016/j.pec.2016.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 02/10/2016] [Accepted: 03/05/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE We investigated vocal characteristics associated with physiologically determined stressful episodes by means of post-hoc acoustic analyses of speech recorded in a clinical setting. Our research addressed the understudied question of which vocal features may serve as cues naturally occurring stress and is the first to explore this issue in a pitch accent language. METHODS The vocal profile of a single female patient interacting with a physician was analyzed with standard speech analysis software for acoustic indicators of stress-related arousal determined by galvanic skin response measurements. RESULTS Vocal jitter, representing an aspect of voice quality perceived as hoarseness, appeared to increase during and immediately after skin conductance response intervals. Skin conductance levels during the response intervals were negatively correlated with acoustic features used to approximate the perception of voice unsteadiness (slope and standard deviation of fundamental frequency). CONCLUSION An acoustic analysis of vocal properties of speech uttered during independently detected skin conductance response intervals revealed individual patterns for some acoustic features linked to stress in earlier studies. PRACTICE IMPLICATIONS Non-invasive methods of arousal detection in physician-patient communication based on acoustic analyses of vocal profiles may, in combination with other analyses, help identify stressful events and thus improve the process of medical information gathering and decision-making.
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Affiliation(s)
| | - Erik Holt
- Department of Behavioural Science, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
| | - Lena Heyn
- Lovisenberg Diaconal University College, Oslo, Norway
| | - Kim Groeneveld
- Tilburg center for Cognition and Communication, Tilburg University, The Netherlands
| | - Arnstein Finset
- Department of Behavioural Science, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
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Ghazali DA, Ragot S, Breque C, Guechi Y, Boureau-Voultoury A, Petitpas F, Oriot D. Randomized controlled trial of multidisciplinary team stress and performance in immersive simulation for management of infant in shock: study protocol. Scand J Trauma Resusc Emerg Med 2016; 24:36. [PMID: 27012938 PMCID: PMC4807574 DOI: 10.1186/s13049-016-0229-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 03/17/2016] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Human error and system failures continue to play a substantial role in adverse outcomes in healthcare. Simulation improves management of patients in critical condition, especially if it is undertaken by a multidisciplinary team. It covers technical skills (technical and therapeutic procedures) and non-technical skills, known as Crisis Resource Management. The relationship between stress and performance is theoretically described by the Yerkes-Dodson law as an inverted U-shaped curve. Performance is very low for a low level of stress and increases with an increased level of stress, up to a point, after which performance decreases and becomes severely impaired. The objectives of this randomized trial are to study the effect of stress on performance and the effect of repeated simulation sessions on performance and stress. METHODS This study is a single-center, investigator-initiated randomized controlled trial including 48 participants distributed in 12 multidisciplinary teams. Each team is made up of 4 persons: an emergency physician, a resident, a nurse, and an ambulance driver who usually constitute a French Emergency Medical Service team. Six multidisciplinary teams are planning to undergo 9 simulation sessions over 1 year (experimental group), and 6 multidisciplinary teams are planning to undergo 3 simulation sessions over 1 year (control group). Evidence of the existence of stress will be assessed according to 3 criteria: biological, electrophysiological, and psychological stress. The impact of stress on overall team performance, technical procedure and teamwork will be evaluated. Participant self-assessment of the perceived impact of simulations on clinical practice will be collected. Detection of post-traumatic stress disorder will be performed by self-assessment questionnaire on the 7(th) day and after 1 month. DISCUSSION We will concomitantly evaluate technical and non-technical performance, and the impact of stress on both. This is the first randomized trial studying repetition of simulation sessions and its impact on both clinical performance and stress, which is explored by objective and subjective assessments. We expect that stress decreases team performance and that repeated simulation will increase it. We expect no variation of stress parameters regardless of the level of performance. TRIAL REGISTRATION ClinicalTrials.gov registration number NCT02424890.
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Affiliation(s)
- Daniel Aiham Ghazali
- Emergency Department and Emergency Medical Service, University Hospital of Poitiers, 2 rue de la Miletrie, Poitiers, 86000, France.
- INSERM-CIC1402, University Hospital of Poitiers, 2 rue de la Miletrie, Poitiers, 86000, France.
- Simulation Laboratory, Faculty of Medicine, University of Poitiers, 6 rue de la Miletrie, Poitiers, 86000, France.
| | - Stéphanie Ragot
- INSERM-CIC1402, University Hospital of Poitiers, 2 rue de la Miletrie, Poitiers, 86000, France
| | - Cyril Breque
- Simulation Laboratory, Faculty of Medicine, University of Poitiers, 6 rue de la Miletrie, Poitiers, 86000, France
| | - Youcef Guechi
- Emergency Department and Emergency Medical Service, University Hospital of Poitiers, 2 rue de la Miletrie, Poitiers, 86000, France
| | - Amélie Boureau-Voultoury
- Pediatric Emergency Department, University Hospital of Poitiers, 2 rue de la Miletrie, Poitiers, 86000, France
| | - Franck Petitpas
- Surgical Critical Care Unit, University Hospital of Poitiers, 2 rue de la Miletrie, Poitiers, 86000, France
| | - Denis Oriot
- Simulation Laboratory, Faculty of Medicine, University of Poitiers, 6 rue de la Miletrie, Poitiers, 86000, France
- Pediatric Emergency Department, University Hospital of Poitiers, 2 rue de la Miletrie, Poitiers, 86000, France
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Shaw J, Brown R, Dunn S. The impact of delivery style on doctors' experience of stress during simulated bad news consultations. PATIENT EDUCATION AND COUNSELING 2015; 98:1255-1259. [PMID: 26320824 DOI: 10.1016/j.pec.2015.08.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 08/14/2015] [Accepted: 08/17/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate the relationship between doctors' bad news delivery style and their experience of physiological stress during simulated bad news consultations. METHODS 31 doctors participated in two simulated breaking bad news (BBN) consultations. Delivery style was categorized as either blunt, forecasting or stalling (i.e. avoidant), based on the time to deliver the bad news and qualitative analysis of the interaction content and doctor's language style. Doctors' heart rate (HR) and skin conductance (SC) were recorded in consecutive 30s epochs. RESULTS Doctors experienced a significant decrease in HR (F(1,36)=44.9, p<.0001) and SC (F(1,48)=5.6, p<.001) between the pre- and post-news delivery phases of the consultation. Between-group comparisons for the three delivery styles did not identify any significant differences in HR (F(2,36)=2.2, p>.05) or SC (F(2,48)=.66, p>.05). CONCLUSION AND PRACTICE IMPLICATIONS Doctors experience heightened stress in the pre-news delivery phase of breaking bad news interactions. Delaying the delivery of bad news exposes doctors to a longer period of increased stress.This suggests that medical students and doctors should be taught to deliver bad news without delay, to help mitigate their response to this stressful encounter.
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Affiliation(s)
- Joanne Shaw
- Psycho-oncology Co-operative Research Group, School of Psychology, The University of Sydney, Sydney Australia.
| | - Rhonda Brown
- Research School of Psychology, ANU College of Medicine, Biology and Environment, The Australian National University, Canberra Australia
| | - Stewart Dunn
- Pam McLean Centre, Sydney Medical School, The University of Sydney, Sydney Australia
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Legg AM, Sweeny K. Blended news delivery in healthcare: a framework for injecting good news into bad news conversations. Health Psychol Rev 2015; 9:452-68. [PMID: 26081524 DOI: 10.1080/17437199.2015.1051567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Clinicians often inject good news into bad news delivery, and they do so for a variety of reasons. We present a framework that draws from research in the fields of health and social psychology to shed light on situations in which clinicians add superfluous good news into bad news conversations in an effort to ease the conversation or mitigate patients' distress, a broad strategy we refer to as blended news delivery. Our framework includes predictors of clinicians' use of blended news delivery, characteristics of blended news and outcomes of this strategy for both patients and clinicians. This framework addresses a common aspect of health communication and can direct future research on ideal strategies for and likely consequences of blended news delivery and communication more broadly.
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Affiliation(s)
- Angela M Legg
- a Department of Psychology , Pace University , 861 Bedford Road, Marks Hall 25, Pleasantville , NY 10570 , USA
| | - Kate Sweeny
- b Department of Psychology , University of California , Riverside , CA , USA
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Romotzky V, Galushko M, Düsterdiek A, Obliers R, Albus C, Ostgathe C, Voltz R. "It's Not that Easy"--Medical Students' Fears and Barriers in End-of-Life Communication. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2015; 30:333-339. [PMID: 25113025 DOI: 10.1007/s13187-014-0712-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This study aims to assess and improve communication education for medical students in palliative care (PC) with the use of simulated patients (SP) in Germany. More specifically, to explore how students evaluate the use of SP for end-of-life communication training and which fears and barriers arise. A pilot course was implemented. Qualitative content analysis was used to analyse transcribed recordings of the course. Pre- and post-course questionnaires containing open-ended questions ascertained students' motivation for participating, their preparation within their degree programme and whether they felt they had learned something important within the course. Seventeen medical students in their third to fourth year of education (age 22-31) participated in the five-session course and answered the questionnaires (pre n = 17, post n = 12). Students felt insufficiently prepared and insecure. Discussing end-of-life issues was experienced as challenging and emotionally moving. Within the conversations, although students sometimes showed blocking behaviour in reaction to emotional impact, they valued the consideration of emotional aspects as very important. The course was overall highly appreciated and valued as being helpful. The communication situation with the SP was perceived as authentic. Ten out of 12 students confirmed to have learned something important (post course). Our results indicate an urgent need for better communication training for medical students. Due to the fact that bedside teaching in PC is not feasible for all students, training with standardized SP can be a way to generate an authentic learning situation. Techniques to address fears and blocking behaviour should, however, also be considered.
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Affiliation(s)
- V Romotzky
- Department of Palliative Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany,
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Reed S, Kassis K, Nagel R, Verbeck N, Mahan JD, Shell R. Breaking bad news is a teachable skill in pediatric residents: A feasibility study of an educational intervention. PATIENT EDUCATION AND COUNSELING 2015; 98:748-752. [PMID: 25775928 DOI: 10.1016/j.pec.2015.02.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 01/20/2015] [Accepted: 02/15/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Patients and physicians identify communication of bad news as a skill in need of improvement. Our objectives were to measure change in performance of first-year pediatric residents in the delivery of bad news after an educational intervention and to measure if changes in performance were sustained over time. METHODS Communication skills of 29 residents were assessed via videotaped standardized patient (SP) encounters at 3 time points: baseline, immediately post-intervention, and 3 months post-intervention. Educational intervention used was the previously published "GRIEV_ING Death Notification Protocol." RESULTS The intraclass correlation coefficient demonstrated substantial inter-rater agreement with the assessment tool. Performance scores significantly improved from baseline to immediate post-intervention. Performance at 3 months post-intervention showed no change in two subscales and small improvement in one subscale. CONCLUSIONS We concluded that breaking bad news is a complex and teachable skill that can be developed in pediatric residents. Improvement was sustained over time, indicating the utility of this educational intervention. PRACTICE IMPLICATIONS This study brings attention to the need for improved communication training, and the feasibility of an education intervention in a large training program. Further work in development of comprehensive communication curricula is necessary in pediatric graduate medical education programs.
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Affiliation(s)
- Suzanne Reed
- Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, USA.
| | - Karyn Kassis
- Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, USA
| | - Rollin Nagel
- The Ohio State University College of Medicine, Columbus, USA
| | - Nicole Verbeck
- The Ohio State University College of Medicine, Columbus, USA
| | - John D Mahan
- Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, USA
| | - Richard Shell
- Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, USA
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Quand perte de sens rime avec souffrance : analyse qualitative du vécu des médecins à l’annonce d’une mauvaise nouvelle en oncologie. PSYCHO-ONCOLOGIE 2015. [DOI: 10.1007/s11839-015-0503-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rouby P, Hollebecque A, Bahleda R, Deutsch E, Gomez-Rocca C, Angevin E, de La Motte Rouge T, Soria JC, Dauchy S. Communication en oncologie dans le cadre d’essais thérapeutiques de phase I : mise en œuvre et évaluation d’un programme de formation. Bull Cancer 2015; 102:174-81. [DOI: 10.1016/j.bulcan.2014.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 04/23/2014] [Indexed: 11/17/2022]
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Sarafis P, Tsounis A, Malliarou M, Lahana E. Disclosing the truth: a dilemma between instilling hope and respecting patient autonomy in everyday clinical practice. Glob J Health Sci 2013; 6:128-37. [PMID: 24576372 PMCID: PMC4825228 DOI: 10.5539/gjhs.v6n2p128] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 10/23/2013] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND While medical ethics place a high value on providing truthful information to patients, disclosure practices are far from being the norm in many countries. Transmitting bad news still remains a big problem that health care professionals face in their every day clinical practice. AIMS Through the review of relevant literature, an attempt to examine the trends in this issue worldwide will be made. METHOD Various electronic databases were searched by the authors and through systematic selection 51 scientific articles were identified that this literature review is based on. RESULTS There are many parameters that lead to the concealment of truth. Factors related to doctors, patients and their close environment, still maintain a strong resistance against disclosure of diagnosis and prognosis in terminally ill patients, while cultural influences lead to different approaches in various countries. Withholding the truth is mainly based in the fear of causing despair to patients. However, fostering a spurious hope, hides the danger of its' total loss, while it can disturb patient-doctor relationship.
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Affiliation(s)
- Pavlos Sarafis
- Faculty of Nursing, Technological Educational Institute of Sterea Ellada.
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Shaw J, Brown R, Heinrich P, Dunn S. Doctors' experience of stress during simulated bad news consultations. PATIENT EDUCATION AND COUNSELING 2013; 93:203-208. [PMID: 23850183 DOI: 10.1016/j.pec.2013.06.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 05/21/2013] [Accepted: 06/09/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Breaking bad news (BBN) is a core component of medicine. Psychophysiological studies confirm the subjective reports of doctors that BBN is a stressful experience. This study investigated doctors' physiological stress responses prior to and during two simulated bad news consultations. METHODS Thirty-one doctors participated in a speech-interaction task and two simulated BBN consultations. Heart rate (HR) and skin conductance (SC) were recorded using consecutive 30-s epochs during each of the interactions. The simulations were video recorded. RESULTS Most doctors showed an early anticipatory increase in HR and SC that peaked during the reading of the case history prior to the BBN consultations. Most doctors then experienced a brief and relatively small stress response. However, about one-third of the doctors showed a significant and sustained stress response. CONCLUSIONS The results suggest that most doctors were cognitively engaged with the BBN tasks, however, a small proportion of doctors might have focused more on their own internal feelings and less on these contextual features. PRACTICE IMPLICATIONS In regards to training medical students and doctors, these results suggest that there is a need to focus more on the impact of these encounters on the doctors, not just their performance during these encounters.
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Affiliation(s)
- Joanne Shaw
- Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia.
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