(17) Medical Students Interpretation of a Challenging Breaking

Bad News Vignette and its Impact on Communication 

  אורית קרניאלי-מילר¹ , שמואל אידלמן², דפנה מיתר¹ 

¹אוניברסיטת תל אביב ²מרכז רפואי רמב"ם

 

 

Purpose: To examine the way in which medical students understand and interpret a patient's story presented in a vignette, and evaluate how their interpretation influences their communication with the patient.

 

Method: Following an intensive breaking bad news (BBN) course, 112 senior medical students at Tel Aviv University read a patient's story presented in a vignette. Then, they were asked to identify issues that required special attention, and to describe how they visualize their communication of a serious diagnosis to the patient presented in the vignette. Using a mixed methods design, the authors analyzed the issues noticed, not noticed, and interpreted from the vignette and the relationship between how the students identified and perceived these issues and their communication in the envisioned encounter.

 

Results: Students identified 49 different issues in total—some mentioned directly and explicitly in the vignette, and others alluding to a wide spectrum of clues provoking a variety of personal interpretations.  Recurring clusters of these issues focused on patients, physicians, and/or relationship challenges. Emotional issues and concerns due to system and technical challenges predominated. The individual impact of reading and interpreting the vignette, i.e., what each student noticed, failed to notice, and his/her interpretations, were found to be strongly related to their focus within the communication and the content they addressed. Issues noticed by them were addressed.

 

Conclusions: These findings suggest that what one perceives in a patients' narrative might shape one's patterns of communication and actions. Physicians' ability to discern and understand their own patterns of recognizing and interpreting issues might enhance their communication skills. Implications for teaching will be presented.