Using an online forum to encourage reflection about difficult conversations in medicine

Medical students encounter many challenging communication situations during the clinical clerkships. We created the Difficult Conversations Online Forum (DC Forum) to give students an opportunity to reflect, debrief, and respond to one another about their experiences.

The DC Forum is a web-based application with structured templates for student posts and responses, along with a mechanism for faculty feedback. It became a required part of the curriculum for third-year medical students in 2003. We content analyzed data collected during the 2003-2004 and 2004-2005 academic years (N=315). All open-ended responses were coded by two members of the research team; the few disagreements were resolved via discussion.

While posts addressed a wide range of topics, more than one-third (35.6%) of students addressed delivering bad news. Nearly half (49.4%) of the students reported they had talked with someone about their difficult conversation, most frequently a resident physician; the suggestions they received varied in terms of helpfulness. Only a small percentage of students (4.7%) reported accessing other resources.

The DC Forum provides a template that encourages reflection and dialogue about challenging communication situations. The online design is feasible, and enables a virtual discussion that can be joined by students regardless of their clerkship schedule or clinical site.

A structured approach for reflection and a simple, safe mechanism for feedback are essential components of the learning process regarding difficult conversations. While the DC Forum was created for medical students, the online approach may prove useful across the continuum of medical education.