MedEdPORTAL (May 2015)
A Challenging Obstetric Communication Experience for Undergraduate Medical Education Using Standardized Patients and Student Self-Reflection
Abstract
Abstract Introduction Communication is an essential component of undergraduate medical training, requiring dedicated and robust educational resources. Obstetrics offers uniquely challenging communication scenarios for which undergraduate students may be unprepared. Methods We developed four obstetric-focused standardized patient (SP) cases to expose medical students to the complex and sensitive nature of obstetric communication in a structured and supportive educational environment. Our objective was to provide opportunities for students to practice and refine communication skills in difficult clinical scenarios and to reflect on strengths and areas of improvement for professional development. The cases were written in Objective Structured Clinical Examination format to be performed by SP actors. We also created a student self-reflection tool modeled after the Calgary-Cambridge Observation Guides, a commonly used medical communication framework, with additional elements for fetal concerns. Our intervention was targeted toward medical students as they prepared for clinical rotations in the third and fourth curricular years. Results This intervention has been used to assess the skills of 21 third-year medical students at the University of Colorado School of Medicine. Self-evaluations completed at the conclusion of each of the cases indicated that participating students valued this educational experience. When asked to remark on skills or abilities they wished to improve in the future, many offered improvements directly related to the core conflict of each encounter. Most students identified at least one improvement they could make in the future, noting both general skills, such as structuring the interview, and more concrete aspects directly related to the case. Discussion Although the direct impact of practicing difficult obstetric-focused clinical communication between student and SP may be unstudied, the feedback received suggests these skills may be transferable to other nonobstetric challenging communication encounters. Postencounter student reflections further support this notion as many of the proposed improvements were applicable to a wide variety of patient encounters. For example, one student was surprised by her reaction to being questioned about her age: She commented that her immediate reaction was defensive, noting that this may have hindered building rapport with the partner. Another student struggled with the partner's insistence on seeing a more senior provider. These are not uncommon obstacles faced by young physicians, and being prepared with a response may reduce stress when similar situations occur on the wards.
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