What you "see" is how you communicate: Medical students' meaning making of a patient's vignette

Abstract

Objectives: To examine how medical students notice issues in a vignette and construct their meaning, and how this construction influences their plan to communicate with the patient.

Methods: Following a breaking bad news course for 112 senior medical students, we qualitatively analyzed the participants' written descriptions of the issues they noticed as requiring special attention, using an Immersion/Crystallization iterative consensus process.

Results: Different students noticed different issues, but no-one noticed all 19 planted issues (Mean of issues noticed by students = 6.77; SD = 2.29). The students wrote about the issues in 46 different ways, representing the diverse meanings they ascribed, ranging from identifying, through inferring, to interpreting while jumping to conclusions. Moreover, for some issues, some students focused on the patient whereas others focused on the physician or the physician-patient relationship. Noticing issues led to preparing for communication with the patient.

Conclusions: Noticing the issues and the subsequent meaning-making process facilitated the preparation to address them in the envisioned encounter.

Practice implications: When teaching communication skills, it would be helpful to focus on increasing students' awareness of the issues they notice or fail to notice and their personal meaning-making process. This might reduce bias and enhance their preparation for effective patient-centered communication.

Keywords: Medical students; Narrative; Physician-patient communication; Written communication.