Jody E Steinauer1, Patricia O'Sullivan, Felisa Preskill, Olle Ten Cate, Arianne Teherani. 1. J.E. Steinauer is professor, Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, School of Medicine, San Francisco, California. P. O'Sullivan is professor, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California. F. Preskill is associate director for innovating education in reproductive health, University of California, San Francisco, School of Medicine, San Francisco, California. O. ten Cate is professor of medical education, University Medical Center Utrecht, Utrecht, the Netherlands. A. Teherani is professor, Division of General Internal Medicine, University of California, San Francisco, School of Medicine, San Francisco, California.
Abstract
PURPOSE: Physicians can find it challenging to provide high-quality care to "difficult patients." While studies support that medical students also find some patients "difficult," little is known about why they do or how being a student affects their perceptions. The authors conducted this study to gain a deeper understanding of students' experiences with "difficult patients" to inform clinical teaching about effective patient communication and patient-centered care. METHOD: In 2016, the authors conducted interviews with fourth-year medical students, who were asked to describe patient interactions in which they felt negative emotions toward the patient, as well as describe the clinical setting and their feelings. The authors audiorecorded and transcribed the interviews. Then, using a constructivist grounded theory approach, they reviewed the transcripts, coded the data using a codebook they had developed, and grouped the codes into themes. RESULTS: Twenty-six students (of 44 volunteers and 180 students invited) were interviewed. Students described negative feelings toward patients and patients' behaviors, which were exacerbated by three situations related to their role and expectations as learners: (1) patients' interference with students' ability to "shine"; (2) patients' interference with students' expectations of patient-centered care; and (3) students' lack of the tools or authority to improve patients' health. CONCLUSIONS: Educators should consider these findings, which can be explained by the professional identity formation and goal orientation theory frameworks, as they teach medical students to provide high-quality care for patients they find "difficult."
PURPOSE: Physicians can find it challenging to provide high-quality care to "difficult patients." While studies support that medical students also find some patients "difficult," little is known about why they do or how being a student affects their perceptions. The authors conducted this study to gain a deeper understanding of students' experiences with "difficult patients" to inform clinical teaching about effective patient communication and patient-centered care. METHOD: In 2016, the authors conducted interviews with fourth-year medical students, who were asked to describe patient interactions in which they felt negative emotions toward the patient, as well as describe the clinical setting and their feelings. The authors audiorecorded and transcribed the interviews. Then, using a constructivist grounded theory approach, they reviewed the transcripts, coded the data using a codebook they had developed, and grouped the codes into themes. RESULTS: Twenty-six students (of 44 volunteers and 180 students invited) were interviewed. Students described negative feelings toward patients and patients' behaviors, which were exacerbated by three situations related to their role and expectations as learners: (1) patients' interference with students' ability to "shine"; (2) patients' interference with students' expectations of patient-centered care; and (3) students' lack of the tools or authority to improve patients' health. CONCLUSIONS: Educators should consider these findings, which can be explained by the professional identity formation and goal orientation theory frameworks, as they teach medical students to provide high-quality care for patients they find "difficult."