Difficult conversations in medicine: an experiential optional course with medical students

Introduction: Although the task of handling emotions during a medical consultation seems to be at least important as if not even more than managing communication (1), medical training rarely undertakes an organized approach to promoting personal awareness and to provide opportunities to explore student’s emotional and cognitive responses to patients (2). This could be useful especially in highly emotional situations, as the bad news communication. A 30 hrs optional course was realized at the Medical School of Milan, with the aim of undertaking the management of emotional aspects in a clinical consultation, starting from what students themselves consider as a difficult conversation in medicine. A pre-post test was used to assess the effects of the course. A satisfaction questionnaire was also used. Methods: Photolangage (3) was used to explore participants’ representations of difficult situations through the use of standardized pictures and as a pre/post test to assess the possible changes in student’s perception. Issues of the course were decided and discussed with the students on the basis of the pre-test results. The course was realized through the use of peculiar teaching tools such as socio drama, family genogram, role-playing, movies and group discussions. At the end of the course the participants’ opinion was collected through 3 open-ended questions investigating strength and weakness points, and suggestions. Results: 15 students, 8 males and 7 females, participated in the course: 5 of them were in their 1st/2nd years of the Medical School, 9 in 3rd/4th and 1in 5th/6th. The themes, chosen in accordance with students’ preferences, were: role of family; sexuality; communications of mistakes; death. Regarding the students’ satisfaction questionnaire and the pre/post photolangage results, a content analysis of the answers is ongoing. Discussion: the study could suggest a new teaching method to improve the undergraduate medical students’ management of emotionally difficult conversations