The Group Objective Structured Clinical Experience: building communication skills in the clinical reasoning context.

OBJECTIVE: Students are rarely taught communication skills in the context of clinical reasoning training. The purpose of this project was to combine the teaching of communication skills using SPs with clinical reasoning exercises in a Group Objective Structured Clinical Experience (GOSCE) to study feasibility of the approach, the effect on learners' self-efficacy and attitude toward learning communication skills, and the effect of providing multiple sources of immediate, collaborative feedback. METHODS: GOSCE sessions were piloted in Pediatrics and Medicine clerkships with students assessing their own performance and receiving formative feedback on communication skills from peers, standardized patients (SPs), and faculty. The sessions were evaluated using a retrospective pre/post-training questionnaire rating changes in self-efficacy and attitudes, and the value of the feedback. RESULTS: Results indicate a positive impact on attitudes toward learning communication skills and self-efficacy regarding communication in the clinical setting. Also, learners considered feedback by peers, SPs, and faculty valuable in each GOSCE. CONCLUSION: The GOSCE is an efficient and learner-centered method to attend to multiple goals of teaching communication skills, clinical reasoning, self-assessment, and giving feedback in a formative setting. PRACTICE IMPLICATIONS: The GOSCE is a low-resource, feasible strategy for experiential learning in communication skills and clinical reasoning.

Bereavement, doubt, and the loved body: a 9/11 meditation.

The experience of firefighters at the site of the World Trade Center collapse, especially their fanatic devotion to the task of body recovery, is examined in an effort to understand their motivations. The need to make physical contact with the body of a deceased loved one is considered in light of the Gospel accounts of the disciples' contact with the resurrected body of Jesus. The need for sensory contact with the loved body is discussed as a crucial element in the process of grief, leading to the process of recovery from traumatic loss.

Religious conversion in a psychotic individual.

The authors describe the case of a man who appeared to have psychotic symptoms, including self-injurious behavior, but who understood his own experience as a religious conversion. The symptoms, clinical course, and treatment response are described with reference to the works of Kurt Schneider and William James. Empirical studies of the attitudes of psychiatrists, psychiatric patients, and clergypersons about the relationship between religious belief and psychiatric illness are described, and various theoretical models used to understand this relationship are articulated.