Browsing by Subject "physician-patient communication"

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    "Great Expectations" : Communication between standardized patients and medical students in Objective Structured Clinical Examinations
    (2007-11-20T16:10:48Z) Budyn, Cynthia Lee; Schrader, Stuart M.; White-Mills, Kim D.; Goering, Elizabeth M.; Schultz, Jane E.
    In relationship-centered care, the relationship formed between physician and patient is critical to the creation of positive patient outcomes and patient satisfaction (Inui, 1996; Laine & Davidoff, 1996; Tresolini, 1994). Medical educators have increasingly utilized Objective Structured Clinical Examinations (OSCEs) to assess medical students’ abilities to utilize a relationship-centered approach in clinical interviewing. OSCEs, however, have recently come under scrutiny as critics contend that the overly scripted and standardized nature of the OSCE may not accurately reflect how medical students build and maintain relationships with patients. Although some studies have looked at how standardized patients help teach medical students interviewing skills, few studies have looked specifically at how the structured nature of the OSCE may influence relationship-building between standardized patients and medical students. Therefore, this study asks the question “How is relationship-centered care negotiated between standardized patients and medical students during a summative diagnostic OSCE?” Using an ethnographic methodology (Bochner & Ellis, 1996), data consists of an ethnographic field journal, transcripts of semi-structured interviews with SPs and medical students, and transcripts of headache and chronic cough videotaped scenarios. Using grounded theory (Strauss & Corbin, 1990, 1998), a back-and-forth thematic analysis was conducted in discovering the saturation of conceptual categories, linking relationships, and in critically comparing interpretive categorical concepts with relevant literature (Josselson & Leeblich, 1999). Findings suggest that standardized patients and medical students hold differing expectations for 1) diagnostic information gathering and 2) making personal connections upon entering a diagnostic summative OSCE. SPs “open up” both verbally and nonverbally when medical students “go beyond the checklist” by asking discrete diagnostic questions and when overtly trying to connect emotionally. Fourth year medical students, however, expect SPs to “open-up” during what they experience as a rushed, time-constrained, and overly structured “gaming” exercise which contradicts their own clinical experiences in being more improvisational during empathetic rapport building. Differences between SPs and medical students’ expectations and communication practices influence how they perform during summative diagnostic OSCEs. Findings may suggest the re-introduction of more relationship-focused OSCEs which positions SPs as proactive patients who reflexively co-teach students about the importance of making personal connections.
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    Shared Presence in Physician-Patient Communication: A Graphic Representation
    (2015-09) Ventres, William B.; Frankel, Richard M.; Department of Medicine, IU School of Medicine
    Shared presence is a state of being in which physicians and patients enter into a deep sense of trust, respect, and knowing that facilitates healing. Communication between physicians and patients (and, in fact, all providers and recipients of health care) is the medium through which shared presence occurs, regardless of the presenting problem, time available, location of care, or clinical history of the patient. Conceptualizing how communication leads to shared presence has been a challenging task, however. Pathways of this process have been routinely lumped together as the biopsychosocial model or patient, person, and relationship-centered care—all deceptive in their simplicity but, in fact, highly complex—or reduced to descriptive explications of one constituent element (e.g., empathy). In this article, we reconcile these pathways and elements by presenting a graphic image for clinicians and teachers in medical education. This conceptual image serves as a framework to synthesize the vast literature on physician-patient communication. We place shared presence, the fundamental characteristic of effective clinical communication, at the center of our figure. Around this focal point, we locate four elemental factors that either contribute to or result from shared presence, including interpersonal skills, relational contexts, actions in clinical encounters, and healing outcomes. By visually presenting various known and emergent theories of physician-patient communication, outlining the flow of successful encounters between physicians and patients, and noting how such encounters can improve outcomes, physicians, other health care professionals, and medical educators can better grasp the complexity, richness, and potential for achieving shared presence with their patients.