Experiences of the medical profession: A qualitative study using narrative facilitators.

BACKGROUND: Physicians' narratives are means to approach and comprehend the practice of medicine, and physicians' embedment in their work and the healthcare context. OBJECTIVE: This study aimed to explore physicians' professional experiences and to examine how they are affected by factors related to their inner (psychological) and outer (institutional and social) worlds. METHODS: The study was designed as an exploratory qualitative study based on "narrative facilitators" (NF). Their goal is to encourage storytelling and to support the narrative process. The analytic approach was specific for each NF. RESULTS: Thirty-three physicians participated in the study. The findings showed a focus on the transformations of a profession, the need for physicians to adapt in terms of role and status, and their withstanding of conflicting projections from the public and patients (NF: press articles). The institutional context was described as not welcoming and impersonal (NF: photo-based story). When reacting to the quotes from their peers, participants showed a variety of un-patterned stances with respect to different aspects of medicine and the medical profession, illustrating heterogeneity with regard to professional attitudes and identities (NF: quotes from biographies/narrative accounts). Finally, findings also indicated that physicians often limited their narratives to a description of the materiality of the elements put into play (NF: blurred video sequences). CONCLUSION: Disenchanted physicians are not beneficial, neither for the patient nor for the health care system, and their feeling of being worn out may do harm and negatively affect themselves and their families.

Virtual patient simulation in breaking bad news training for medical students.

OBJECTIVE: The present study explores students' perspective on the added value of a virtual patient (VP) simulation as part of a breaking bad news training in undergraduate medical education. METHODS: The VP simulation allows trying out and practicing different ways of disclosing a cancer diagnosis to a VP (avatar) and to react to emotionally-laden patient statements with the opportunity of self-observation through video recording. After testing the simulation, 23 students shared their experience in focus groups analyzed using thematic analysis. RESULTS: Self-observation is the most valued feature of the simulation, because it enables users to reflect on their behaviors and adjust them. The competences developed are otherwise technical (e.g., organization of information) and concern less interactional competences. Areas for improvement of the simulation are the interactivity, quality, and diversity of the VPs. CONCLUSION: The findings show that VP simulations help develop technical communication competences and are best suited as add-ons to other forms of training, in which relational aspects can be targeted. Self-observation is especially valued because it allows for a critical view regarding one's own communication behaviors in a stress-free environment. PRACTICE IMPLICATIONS: The proposed simulation is beneficial as an add-on to lectures, supervision, and simulated patient interviews.