Beyond Competency: A Student Perspective on Growth Through Clerkship Feedback.

This article proposes a paradigm shift from the competency-based model of clerkship feedback using checklists to a coaching-based, action plan-oriented process that centers on individualized student-oriented goals. Using a student perspective, the authors examine the feedback literature and put forward a proposal to use an impact model whose emphasis is to improve the learning climate for students. Several techniques are reviewed which include goal generation and creation of dynamic action plans. By intentionally focusing on coaching relationships as a platform for feedback, the learners and mentors share goals and the result of feedback becomes action-based behaviors which may help negate personal attribution and bias in the feedback process.

Predictors of medical students' ethical decision-making: A pilot study using the Theory of Interpersonal Behavior.

OBJECTIVE: To understand medical students' (MS) ethical decision-making using the Theory of Interpersonal Behavior (TIB). METHODS: We conducted two rounds of focus groups to develop a TIB-based questionnaire by eliciting students' perspectives on an ethical dilemma they will encounter in a standardized patient (SP) station, in which an SP "surgeon" asked them to intubate a sedated patient whom the student knew had requested no student involvement. We administrated questionnaires to 241 third-year MS following this SP station, asking for their decisions in the SP station and if a surgeon made the same request in their clerkship. Confirmatory factor analysis (CFA) was used to test whether observed data fit the proposed TIB-based model. RESULTS: The CFA provided an acceptable fit to the a priori proposed model. Fifty-five percent of students indicated they would intubate in an actual situation versus 18% in the SP station (p < 0.05). Using logistic regression, TIB domains affect and facilitating factors reported significant association with students' decisions in both the SP and hypothesized actual situations. CONCLUSIONS: The TIB appears to be an effective theoretical framework for explaining students' ethical decision-making. PRACTICE IMPLICATIONS: The TIB may guide design and assessment of educational programs for professional formation.

Communication skills teaching in Brazilian medical schools: What lessons can be learned?

OBJECTIVE: To assess current practices in communication skills (CS) teaching in Brazilian medical schools (MS), looking for similarities and differences with other countries. METHODS: This study was performed with 162 out of the 237 accredited Brazilian MS (68.35%). The quantitative data were analyzed using descriptive statistics and qualitative data using content analysis. RESULTS: 104 MS (64.2%) reported formal CS training. CS were more commonly taught in the pre-clinical years, by physicians and psychologists. Compared to other countries, Brazil was unique in offering training for "acolhimento" ("embracement"), which is a Brazilian Government strategy that requires that all those connected with healthcare delivery, from administrators to practitioners, and all allied health personnel "embrace" a dedication to caring for patients and the communities in which they live. CONCLUSIONS: Formal CS teaching in Brazilian MS is less frequently seen in MS curriculum compared to reported data from other countries. The CS teaching of "embracement" is unique to Brazil. PRACTICE IMPLICATIONS: This study adds to the literature by identifying the CS teaching of "embracement" in Brazilian MS, which could be considered outside Brazil.

Preserving third year medical students' empathy and enhancing self-reflection using small group "virtual hangout" technology.

BACKGROUND: Medical student professionalism education is challenging in scope, purpose, and delivery, particularly in the clinical years when students in large universities are dispersed across multiple clinical sites. We initiated a faculty-facilitated, peer small group course for our third year students, creating virtual classrooms using social networking and online learning management system technologies. The course emphasized narrative self-reflection, group inquiry, and peer support. METHODS: We conducted this study to analyze the effects of a professionalism course on third year medical students' empathy and self-reflection (two elements of professionalism) and their perceptions about the course. Students completed the Groningen Reflection Ability Scale (GRAS) and the Jefferson Scale of Empathy (JSE) before and after the course and provided anonymous online feedback. RESULTS: The results of the JSE before and after the course demonstrated preservation of empathy rather than its decline. In addition, there was a statistically significant increase in GRAS scores (p < 0.001), suggesting that the sharing of personal narratives may foster reflective ability and reflective practice among third year students. CONCLUSION: This study supports previous findings showing that students benefit from peer groups and discussion in a safe environment, which may include the use of a virtual group video platform.

Residents' and standardized patients' perspectives on empathy: issues of agreement.

OBJECTIVE: We investigated correlations between residents' scores on the Jefferson Scale of Empathy (JSE), residents' perceptions of their empathy during standardized-patient encounters, and the perceptions of standardized patients. METHODS: Participants were 214 first-year residents in internal medicine or family medicine from 13 residency programs taking standardized patient-based clinical skills assessment in 2011. We analyzed correlations between residents' JSE scores; standardized patients' perspectives on residents' empathy during OSCE encounters, using the Jefferson Scale of Patient Perceptions of Physician Empathy; and residents' perspectives on their own empathy, using a modified version of this scale. RESULTS: Residents' JSE scores correlated with their perceptions of their own empathy during encounters but correlated poorly with patients' assessments of resident empathy. CONCLUSION: The poor correlation between residents' and standardized patients' assessments of residents' empathy raises questions about residents' abilities to gauge the effectiveness of their empathic communications. The study also points to a lack of congruence between the assessment of empathy by standardized patients and residents as receivers and conveyors of empathy, respectively. PRACTICE IMPLICATIONS: This study adds to the literature on empathy as a teachable skill set and raises questions about use of OSCEs to assess trainee empathy.

How to integrate the electronic health record and patient-centered communication into the medical visit: a skills-based approach.

BACKGROUND: Implementation of the electronic health record (EHR) has changed the dynamics of doctor-patient communication. Physicians train to use EHRs from a technical standpoint, giving only minimal attention to integrating the human dimensions of the doctor-patient relationship into the computer-accompanied medical visit. DESCRIPTION: This article reviews the literature and proposes a model to help clinicians, residents, and students improve physician-patient communication while using the EHR. EVALUATION: We conducted a literature search on use of communication skills when interfacing with the EHR. We observed an instructional gap and developed a model using evidence-based communication skills. CONCLUSION: This model integrates patient-centered interview skills and aims to empower physicians to remain patient centered while effectively using EHRs. It may also serve as a template for future educational and practice interventions for use of the EHR in the examination room.