Background Students in their clinical years practice taking histories from patients on the wards. Junior doctors and nursing staff help the students to identify patients clerk, often selecting ‘suitable’ patients. The dissimilarity between these selected patients to the true patient population leaves students without the experience in clerking in more difficult circumstances. We wanted to increase students’ experience with clerking more challenging patients.
Method We used focus groups with junior doctors and medical student to identify the difficult historians. The four classic difficult historians were identified as: (1) the confused patient, (2) aggressive, (3) upset and (4) chatty. We designed a high-fidelity communication workshop to give the students exposure to these patients in a safe environment. There were four stations, each with a simulated patient playing one of the difficult historians. Students rotated around the four stations in pairs, taking it in turns to spend 10 min taking a history. Students received highly-specific, individual feedback at the end of each station from their peer, the teacher and the simulated patient.
Results We used an anonymous paper questionnaire to collect quantitative and qualitative feedback using free text boxes and 10-point Likert scales.
Angry patient: Students reported an improved awareness from 7.72 to 9.00 (p-value 0.0019). Their confidence in management improved from 5.57 to 7.84 (p-value <0.0001).
Upset patient: Awareness improved from 8.40 to 9.20 (p-value 0.0298) and confidence with management increased from 7.92 to 8.76 (p-value 0.0073).
Chatty patient: There was an improvement in awareness from 8.57 to 9.06 (p-value 0.13) and the students’ confidence with management improved from 7.06 to 8.48 (p-value <0.0001).
Confused patient: Students’ awareness increased from 8.36 to 9.27 (p-value 0.0044) and their confidence improved from 6.69 to 8.63 (p-value <0.0001).
Recommendations We hope to extend this workshop to other year groups and other academies.
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