Medical students' reflections on emotions concerning breaking bad news.

OBJECTIVES: To gain a deeper understanding of fourth year medical students' reflections on emotions in the context of breaking bad news (BBN). METHODS: During the years 2010-2012, students reflected on their emotions concerning BBN in a learning assignment at the end of the communications skills course. The students were asked to write a description of how they felt about a BBN case. The reflections were analysed using qualitative content analysis. RESULTS: 351 students agreed to participate in the study. We recognized ten categories in students' reflections namely empathy, insecurity, anxiety, sadness, ambivalence, guilt, hope, frustration, gratefulness and emotional detachment. Most students expressed empathy, but there was a clear tension between feeling empathy and retaining professional distance by emotional detachment. CONCLUSIONS: Students experience strong and perplexing emotions during their studies, especially in challenging situations. A deeper understanding of students' emotions is valuable for supporting students' professional development and coping in their work in the future. PRACTICE IMPLICATIONS: Medical students need opportunities to reflect on emotional experiences during their education to find strategies for coping with them. Emotions should be actively discussed in studies where the issues of BBN are addressed. Teachers need education in attending emotional issues constructively.