Physicians' emotion awareness and emotion regulation training during medical education: a systematic scoping review protocol.

INTRODUCTION: The objective of this systematic scoping review is to identify what approaches have been implemented in medical education programmes to teach medical students the skills to identify and manage emotions that may be elicited in them during physician-patient interactions and in the clinical environment. Emotions of all involved in the clinical encounter are central to the process of clinical care. However, a gap remains addressing and teaching medical students about recognising and dealing with their own emotions. METHODS AND ANALYSIS: This scoping review will follow the updated JBI (The Johanna Briggs Institute) methodology guidance for the conduct and reporting of systematic scoping reviews, and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. A search strategy was developed and applied to five databases. Terms used included medical education, medical curriculum, medical students, emotion (regulation), psychological well-being and mental health. Additionally, a grey literature and reference list search will be conducted. Two independent reviewers will first screen titles and abstracts followed by a second, full-text screening phase. Publications to be included will contain information and data about teaching approaches such as lectures, and other teaching material on physicians' emotion awareness and emotion regulation training in medical education. ETHICS AND DISSEMINATION: This study will review existing literature on emotion awareness and emotion regulation training in medical education, and a systematic scoping review does not require ethical approval. The results of this scoping review will be submitted for publication to relevant peer-reviewed journals and will be used to inform the development and implementation of training programmes and research studies aimed at preparing medical students to identify and manage their own emotions in the clinical environment.

[Medical students facing death : death is the only certainty in life]. / Étudiant-e-s en médecine face à la mort : chassez le spectre, il revient au galop.

Every medical student is confronted with death at some point in his/her career. This inevitable experience is often accompanied by intense emotions, both enriching and painful. However, too little attention is paid to these aspects during the training course, and the support given to students by their trainers is often uncertain. We will discuss these aspects here, along with a few ideas for improvement, based on the international literature and our own experience in the field.

Toute étudiante en médecine est, à un moment ou un autre de son parcours, confrontée à la mort. Cette expérience inévitable est bien souvent accompagnée d'intenses émotions, enrichissantes ou douloureuses. Ces aspects sont cependant trop peu abordés durant le cursus de formation, parallèlement à un accompagnement bien souvent aléatoire des étudiantes par leurs formateurs-trices. Nous évoquons ici ces aspects ainsi que quelques pistes d'amélioration, en nous basant sur la littérature internationale et notre expérience de terrain.

[How To Teach Uncertainty Management]. / Pédagogie de l'incertitude en médecine.

In this article, we propose a model to teach uncertainty management. Our primary goal is to define the concept of uncertainty and its stakes. We then discuss the effect that uncertainty may have on physicians and patients. We finally present reliable strategies to address medical complexity and how to teach or assess complexity management.

L'objectif de cet article est d'apporter des pistes pédagogiques permettant d'enseigner la gestion de l'incertitude en médecine. En premier lieu, il s'agit de formuler une définition du concept d'incertitude afin d'en comprendre les enjeux. Nous discuterons également des conséquences d'une mauvaise tolérance de l'incertitude pour le médecin et pour le patient. Enfin, nous verrons différentes stratégies qui permettent de mieux appréhender la complexité des situations médicales et quels pourraient être les moyens d'enseigner ou d'évaluer l'incertitude.

'Demystifying' the encounter with adolescent patients: a qualitative study on medical students' experiences and perspectives during training with adolescent simulated patients.

Training with adolescent simulated patients (ASP) is increasingly recognized as an effective form of teaching interviewing skills with adolescent patients. Beyond the acknowledged effectiveness and satisfaction of training with ASP, little is known on medical students' actual experience and specific learning needs related to simulated encounters with ASP, as well as factors influencing their learning experience.The aim of this study was an in-depth exploration of medical students' perspectives about training with ASP.Using a qualitative design with grounded theory methods, we conducted in-field observation of training sessions with ASP and individual interviews with eighteen fourth-year medical students participating in training.When provided with an actual experience in a simulated setting, students go through a process of anticipating then modulating the challenge of the encounter with an adolescent patient. This challenge is influenced and modulated within 3 main dimensions: preconceptions about adolescents, level of experience with adolescent patients and professional distance. This process is also influenced by how students perceive and cope with the educational setting.Training with ASP, as a first concrete experience of an adolescent consultation, is an opportunity to address important aspects of students' attitudes towards adolescent patients such as students' preconceptions, personal experiences and feelings that could influence the doctor-patient relationship later on. Training should focus on ways to reflect upon and handle such attitudes and the emotional resonance experienced by medical students.

Improving the assessment of communication competencies in a national licensing OSCE: lessons learned from an experts' symposium.

BACKGROUND: As the communication competencies of physicians are crucial for providing optimal patient care, their assessment in the context of the high-stakes Objective Structured Clinical Examination (OSCE) is of paramount importance. Despite abundant literature on the topic, evidence-based recommendations for the assessment of communication competencies in high stakes OSCEs are scarce. As part of a national project to improve communication-competencies assessments in the Swiss licensing exam, we held a symposium with national and international experts to derive corresponding guidelines. METHODS: Experts were invited on account of their recognized expertise either in teaching or assessing communication competencies, or in conducting national high-stakes OSCEs. They were asked to propose concrete solutions related to four potential areas for improvement: the station design, the rating tool, the raters' training, and the role of standardized patients. Data gene.rated in the symposium was available for analysis and consisted of video recordings of plenary sessions, of the written summaries of group work, and the cards with participants' personal take-home messages. Data were analyzed using a thematic analysis approach. RESULTS: Nine major suggestions for improving communication-competencies assessments emerged from the analysis and were classified into four categories, namely, the roles of the OSCE scenarios, rating tool, raters' training, and simulated patients. CONCLUSION: In the absence of established evidence-based guidelines, an experts' symposium facilitated the identification of nine practical suggestions for improving the assessment of communication competencies in the context of high-stakes OSCEs. Further research is needed to test effectiveness of the suggestions and how they contribute to improvements in the quality of high-stakes communication-competencies assessment.

Nationwide introduction of a new competency framework for undergraduate medical curricula: a collaborative approach.

Switzerland recently introduced PROFILES, a revised version of its national outcomes reference framework for the undergraduate medical curriculum. PROFILES is based on a set of competencies adapted from the CanMEDS framework and nine entrustable professional activities (EPAs) that students have to be able to perform autonomously in the context of a predefined list of clinical situations. The nationwide implementation of such a competency- and EPA-based approach to medical education is a complex process that represents an important change to the organisation of undergraduate training in the various medical schools. At the same time, the concepts underlying PROFILES also have to be reflected at the level of the Federal Licencing Examination (FLE) and the national accreditation process. The vice-deans for education mandated a Swiss Working Group for PROFILES Implementation (SWGPI) to elaborate a guide presenting the principles and best practices based on the current scientific literature, to ensure the coherence between the future developments of the medical curricula and the evolution of the FLE, and to propose a coordinated research agenda to evaluate the implementation process. On the basis of the literature and analysis of our national context, we determined the key elements important for a successful implementation. They can be grouped into several areas including curricular design and governance, the assessment system and entrustment process, faculty development and change management. We also identified two dimensions that will be of particular importance to create synergies and facilitate exchange between the medical schools: a systematic approach to curriculum mapping and the longitudinal integration of an e-portfolio to support the student learning process. The nationwide collaborative approach to define strategies and conditions for the implementation of a new reference framework has allowed to develop a shared understanding of the implications of PROFILES, to promote the establishment of Swiss mapping and e-portfolio communities, and to establish the conditions necessary for ensuring the continuous alignment of the FLE with the evolving medical curricula.

Looking back: twenty years of reforming undergraduate medical training and curriculum frameworks in Switzerland.

Introduction: To date, hardly any reports exist that outline the reforms in medical studies in Switzerland from the first partial reforms in the 1970s until today. Methods: This article outlines the recent history of medical curricula, their reforms in the early 1970s and, based on these, the key reasons for the major curricular reforms of the 2000s from the perspective of the authors. Results: The various projects, initiatives and legislative elements at the national level include the introduction of new quality control instruments - federal examination and programme accreditation, the introduction of a national catalogue of learning objectives and its two follow-up editions, as well as the implementation of the Bologna reform in undergraduate medical curricula. Examples of the key new elements found in all medical training in Switzerland include: the interdisciplinary orientation of learning content in organ and functional system-oriented subject areas or modules, the enhanced valorisation of practical clinical training, as well as the introduction of problem-oriented formats and the integration of partly formative, partly summative exams according to the format of the objective structured practical examination (OSCE). Characteristics unique to the four medical faculties and their medical training programme are also highlighted. Discussion: The described projects, initiatives and legislative elements have led to a dynamic, continuous development of medical curricula in Switzerland. The close cooperation between the faculties and the Federal Office of Public Health (FOPH) has also resulted in a redefinition of the roles and responsibilities of universities and the Federal Government according to the new Law on Medical Professions. This guarantees the medical faculties a great deal of autonomy, without neglecting quality assurance.

Integrated problem-based learning versus lectures: a path analysis modelling of the relationships between educational context and learning approaches.

Students' approaches to learning are central to the process of learning. Previous research has revealed that influencing students' approaches towards deep learning is a complex process and seems much more difficult than expected, even in student-activating learning environments. There is evidence that learning approaches are impacted not only by the learning environment, but also by how students perceive it. However the nature of the links between the environment itself, the way in which it is perceived by students and students' learning approaches is poorly understood. This study aimed at investigating the relationships between students' perception of their educational context and learning approaches in three learning environments differing by their teaching formats (lecture or problem-based-learning PBL) and integration level of the curriculum (traditional or integrated). We tested the hypothesis that a PBL format and an integrated curriculum are associated to deeper approaches to learning and that this is mediated by student perception. The study sample was constituted of 1394 medical students trained respectively in a traditional lecture-based (n = 295), in an integrated lecture-based (n = 612) and in an integrated PBL-based (n = 487) curricula. They completed a survey including the Dundee-Ready-Educational-Environment-Measure (students' perceptions of the educational environment) and the Revised-Study-Process-Questionnaire (learning approaches). Data were analysed by path analysis. The model showed that the learning environment was related to students' learning approaches by two paths, one direct and one mediated via students' perception of their educational context. In the lecture-based curricula students' used deeper approaches when it was integrated and both paths were cumulative. In the PBL-based curriculum students' did not use deeper approaches than with lectures, due to opposite effects of both paths. This study suggested that an integrated lecture-based curriculum was as effective as a PBL curriculum in promoting students' deep learning approaches, reinforcing the importance of integrating the curriculum before choosing the teaching format.

[Addiction-related clinical practice in hospital setting : from specialization to responsibilization]. / La clinique des addictions en milieu hospitalier : entre spécialisation et responsabilisation.

Over the past two years, the Swiss Institute for Postgraduate and Further Education in Medicine has implemented a new certification in addiction medicine and an in-depth training in addiction psychiatry and psychotherapy. These developments contribute to the recognition of a specialty and the training of a new generation of specialized clinicians. This context leads to the question of the role and the skills to be passed on to non-specialists when taking care of drug addiction. This article focuses on the importance of preparing non-specialized clinicians in the hospital setting and presents two prerequisites for improving their training: to explore clinicians' field experience and to make the individual and institutional actors aware of their responsibility.

Au cours des deux dernières années, l'ISFM (Institut suisse pour la formation médicale postgraduée et continue) a établi le cadre d'une nouvelle certification en médecine de l'addiction et d'une formation approfondie en psychiatrie et psychothérapie des addictions. Ces développements contribuent à la reconnaissance d'une spécialité et à la formation d'une nouvelle génération de cliniciens spécialistes. Dans ce contexte, se pose la question du rôle et des compétences à transmettre aux non-spécialistes, notamment à l'hôpital, pièce maîtresse de la prise en charge des personnes souffrant d'un problème d'addiction aux substances. Cet article décrit l'importance de préparer les cliniciens non spécialistes sur le terrain hospitalier et évoque deux prérequis à l'amélioration de leur préparation : explorer les expériences de terrain et responsabiliser les acteurs.

Return of the cadaver: Key role of anatomic dissection for plastic surgery resident training.

Successful Plastic Surgery Residency training is subjected to evolving society pressure of lower hourly work weeks imposed by external committees, labor laws, and increased public awareness of patient care quality. Although innovative measures for simulation training of surgery are appearing, there is also the realization that basic anatomy training should be re-enforced and cadaver dissection is of utmost importance for surgical techniques.In the development of new technology for implantable neurostimulatory electrodes for the management of phantom limb pain in amputee patients, a design of a cadaveric model has been developed with detailed steps for innovative transfascicular insertion of electrodes. Overall design for electrode and cable implantation transcutaneous was established and an operating protocol devised.Microsurgery of the nerves of the upper extremities for interfascicular electrode implantation is described for the first time. Design of electrode implantation in cadaver specimens was adapted with a trocar delivery of cables and electrodes transcutaneous and stabilization of the electrode by suturing along the nerve. In addition, the overall operating arena environment with specific positions of the multidisciplinary team necessary for implantable electrodes was elaborated to assure optimal operating conditions and procedures during the organization of a first-in-man implantation study.Overall importance of plastic surgery training for new and highly technical procedures is of importance and particularly there is a real need to continue actual cadaveric training due to patient variability for nerve anatomic structures.

Individual training at the undergraduate level to promote competence in breaking bad news in oncology.

OBJECTIVE: Training medical students in breaking bad news (BBN) in oncology may be key to improve patient care in an area where many physicians tend to be uncomfortable. Given the lack of evidence in the literature, this study aimed to assess empirically the impact of 2 teaching strategies to prepare students for the task of BBN in oncology: one-to-one simulated patient (SP) training with individual feedback (intervention group) vs small-group SP training with collective feedback (comparison group). METHODS: Fourth-year students (N = 236) were randomly assigned to the intervention or comparison group. The SP videotaped interviews were analyzed with respect to BBN communication performance, rated using the Calgary-Cambridge checklist of teaching objectives for BBN; verbal interaction behaviors, coded with the Roter interaction analysis system; and 7 nonverbal behaviors. RESULTS: Students in the intervention group scored significantly higher after than before the training on the overall evaluation of the interview (P < .001) as well as on process skills (P < .001); they also obtained significantly higher scores compared to students in the comparison group on the overall evaluation of the interview (P < .001) and on process skills (P < .001). CONCLUSIONS: This study supports an individualized BBN teaching strategy and contributes to efforts to find the best way to train and reach the largest number of future physicians to improve communication competences in oncology.

Standardized Patients' Perspectives on Workplace Satisfaction and Work-Related Relationships: A Multicenter Study.

INTRODUCTION: The use of standardized patients (SPs) in health care education has grown in the last 50 years. In addition, the requirements for SPs have increased steadily, and thus, the work of SPs has become more difficult and demanding. It has been claimed that SP programs are highly contextualized, having emerged from local, institutional, professional, and national conditions, but their effects on SPs have not been investigated. We have studied the effects of this job development on SPs and their programs. METHODS: The study was conducted using a qualitative research design, with semistructured individual in-depth interviews to understand the reactions, values, and perceptions that underlie and influence SP behavior. To cover SP perspectives from more than 1 SP program, a total of 15 SPs from 8 different nursing schools and medical schools in Switzerland were asked to participate. RESULTS: Standardized patients feel motivated, engaged, and willing to invest effort in their task and do not mind demands increasing as long as the social environment in SP programs is supportive. The role of the SP trainer and the use of feedback are considered very important. CONCLUSIONS: Standardized patient programs require concepts in which the SP perspective has been integrated to better serve SPs' well-being. Standardized patients are valuable partners in the training of health professionals-we need to take care of them.

Cultural competence and simulated patients.

BACKGROUND: Cultural competence education is central in addressing the socio-cultural factors that affect health care; however, there is little agreement over the best teaching approach. Although simulated patients are widely used in medical education, little is known about their application to cultural competence education. CONTEXT: At the Department of Ambulatory Care and Community Medicine, University of Lausanne, the content of a cultural competence education module for resident doctors was recently restructured, with a final session emphasising previous principles through a simulated patient-doctor encounter. INNOVATION: We tested the feasibility of cultural competence training with simulated patients. We created two complementary case scenarios based on real clinical practice and focused on specific clinical skills. An interdisciplinary team trained two simulated patients, and a 90-minute pilot session took place. General satisfaction was high and the increased opportunity for interaction was greatly appreciated. According to the learners, the simulated case setting was relevant for improving self-reflection and cultural sensitivity: applying skills in the session enhanced perceived impact for 'real-world' practice. We tested the feasibility of cultural competence training with simulated patients IMPLICATIONS: The use of patient-centred simulated clinical practice as a teaching approach seems to be advantageous in increasing providers' self-reflection about cultural competence and intensifying the impact of cultural competence education in clinical practice, and hopefully will improve the quality of care for every patient. Case scenarios based on a diversity of socio-cultural factors and oriented towards a broad skills set would seem preferable to avoid cultural drift and to enhance the learning of cultural approaches that are adaptable to every patient.

The new final Clinical Skills examination in human medicine in Switzerland: Essential steps of exam development, implementation and evaluation, and central insights from the perspective of the national Working Group.

OBJECTIVE: Since 2011, the new national final examination in human medicine has been implemented in Switzerland, with a structured clinical-practical part in the OSCE format. From the perspective of the national Working Group, the current article describes the essential steps in the development, implementation and evaluation of the Federal Licensing Examination Clinical Skills (FLE CS) as well as the applied quality assurance measures. Finally, central insights gained from the last years are presented. METHODS: Based on the principles of action research, the FLE CS is in a constant state of further development. On the foundation of systematically documented experiences from previous years, in the Working Group, unresolved questions are discussed and resulting solution approaches are substantiated (planning), implemented in the examination (implementation) and subsequently evaluated (reflection). The presented results are the product of this iterative procedure. RESULTS: The FLE CS is created by experts from all faculties and subject areas in a multistage process. The examination is administered in German and French on a decentralised basis and consists of twelve interdisciplinary stations per candidate. As important quality assurance measures, the national Review Board (content validation) and the meetings of the standardised patient trainers (standardisation) have proven worthwhile. The statistical analyses show good measurement reliability and support the construct validity of the examination. Among the central insights of the past years, it has been established that the consistent implementation of the principles of action research contributes to the successful further development of the examination. CONCLUSION: The centrally coordinated, collaborative-iterative process, incorporating experts from all faculties, makes a fundamental contribution to the quality of the FLE CS. The processes and insights presented here can be useful for others planning a similar undertaking.

The use of video in standardized patient training to improve portrayal accuracy: A randomized post-test control group study.

INTRODUCTION: High-stake objective structured clinical examinations (OSCEs) with standardized patients (SPs) should offer the same conditions to all candidates throughout the exam. SP performance should therefore be as close to the original role script as possible during all encounters. In this study, we examined the impact of video in SP training on SPs' role accuracy, investigating how the use of different types of video during SP training improves the accuracy of SP portrayal. METHODS: In a randomized post-test, control group design three groups of 12 SPs each with different types of video training and one control group of 12 SPs without video use in SP training were compared. The three intervention groups used role-modeling video, performance-feedback video, or a combination of both. Each SP from each group had four students encounter. Two blinded faculty members rated the 192 video-recorded encounters, using a case-specific rating instrument to assess SPs' role accuracy. RESULTS: SPs trained by video showed significantly (p < 0.001) better role accuracy than SPs trained without video over the four sequential portrayals. There was no difference between the three types of video training. DISCUSSION: Use of video during SP training enhances the accuracy of SP portrayal compared with no video, regardless of the type of video intervention used.

Well, you have hepatic metastases: Use of technical language by medical students in simulated patient interviews.

OBJECTIVE: This research explored medical students' use and perception of technical language in a practical training setting to enhance skills in breaking bad news in oncology. METHODS: Terms potentially confusing to laypeople were selected from 108 videotaped interviews conducted in an undergraduate Communication Skills Training. A subset of these terms was included in a questionnaire completed by students (N=111) with the aim of gaining insight into their perceptions of different speech registers and of patient understanding. Excerpts of interviews were analyzed qualitatively to investigate students' communication strategies with respect to these technical terms. RESULTS: Fewer than half of the terms were clarified. Students checked for simulated patients' understanding of the terms palliative and metastasis/to metastasize in 22-23% of the interviews. The term ambulatory was spontaneously explained in 75% of the interviews, hepatic and metastasis/to metastasize in 22-24%. Most provided explanations were in plain language; metastasis/to metastasize and ganglion/ganglionic were among terms most frequently explained in technical language. CONCLUSION: A significant number of terms potentially unfamiliar and confusing to patients remained unclarified in training interviews conducted by senior medical students, even when they perceived the terms as technical. PRACTICE IMPLICATIONS: This exploration may offer important insights for improving future physicians' skills.

The new licencing examination for human medicine: from concept to implementation.

A new Swiss federal licencing examination for human medicine (FLE) was developed and released in 2011. This paper describes the process from concept design to the first results obtained on implementation of the new examination. The development process was based on the Federal Act on University Medical Professions and involved all national stakeholders in this venture. During this process questions relating to the assessment aims, the assessment formats, the assessment dimensions, the examination content and necessary trade-offs were clarified. The aims were to create a feasible, fair, valid and psychometrically sound examination in accordance with international standards, thereby indicating the expected knowledge and skills level at the end of undergraduate medical education. Finally, a centrally managed and locally administered examination comprising a written multiple-choice element and a practical "clinical skills" test in the objective structured clinical examination (OSCE) format was developed. The first two administrations of the new FLE show that the examination concept could be implemented as intended. The anticipated psychometric indices were achieved and the results support the validity of the examination. Possible changes to the format or content in the future are discussed.

Medical students' skills and needs for training in breaking bad news.

This study assessed medical students' perception of individual vs. group training in breaking bad news (BBN) and explored training needs in BBN. Master-level students (N = 124) were randomised to group training (GT)-where only one or two students per group conducted a simulated patient (SP) interview, which was discussed collectively with the faculty-or individual training (IT)-where each student conducted an SP interview, which was discussed during individual supervision. Training evaluation was based on questionnaires, and the videotaped interviews were rated using the Roter Interaction Analysis System. Students were globally satisfied with the training. Still, there were noticeable differences between students performing an interview (GT/IT) and students observing interviews (GT). The analysis of the interviews showed significant differences according to scenarios and to gender. Active involvement through SP interviews seems required for students to feel able to reach training objectives. The evaluation of communication skills, revealing a baseline heterogeneity, supports individualised training.

Training medical students to conduct motivational interviewing: a randomized controlled trial.

OBJECTIVE: To examine the effectiveness of motivational interviewing (MI) training among medical students. METHODS: All students (n=131) (year 5) at Lausanne Medical School, Switzerland were randomized into an experimental or a control group. After a training in basic communication skills (control condition), an 8-h MI training was completed by 84.8% students in the exprimental group. One week later, students in both groups were invited to meet with two standardized patients. MI skills were coded by blinded research assistants using the Motivational Interviewing Treatment Integrity 3.0. RESULTS: Superior MI performance was shown for trained versus control students, as demonstrated by higher scores for "Empathy" [p<0.001] and "MI Spirit" [p<0.001]. Scores were similar between groups for "Direction", indicating that students in both groups invited the patient to talk about behavior change. Behavior counts assessment demonstrated better performance in MI in trained versus untrained students regarding occurences of MI-adherent behavior [p<0.001], MI non-adherent behavior [p<0.001], Closed questions [p<0.001], Open questions [p=0.001], simple reflections [p=0.03], and Complex reflections [p<0.001]. Occurrences were similar between groups regarding "Giving information". CONCLUSION: An 8-h training workshop was associated with improved MI performance. PRACTICE IMPLICATIONS: These findings lend support for the implementation of MI training in medical schools.