Education Research: Difficult conversations in neurology: Lessons learned from medical students

Area of Science:

• Medical Education
• Neurology
• Communication Skills Training

Background:

• Difficult conversations are integral to medical training.
• Neurology clerkships offer frequent opportunities for communication skills development.

Purpose of the Study:

• To characterize medical student exposure to difficult conversations during neurology core clerkships.
• To assess the impact of exposure on perceived preparedness for future communication challenges.

Main Methods:

• Cross-sectional, mixed-methods study involving 159 medical students.
• Data collected via electronic trackers, surveys, and focus groups.
• Students logged conversations about disability, prognosis, uncertainty, and end-of-life care.

Main Results:

• 70% of students observed at least one difficult conversation, most commonly concerning poor prognosis or new disability.
• Exposure did not improve perceived preparedness to lead difficult conversations.
• 87% of students desired more bedside communication training.

Conclusions:

• Difficult conversations are common in neurology and offer valuable training opportunities.
• Current observational learning may be insufficient for skill development.
• Curricula should incorporate structured training, including pre-conversation planning and debriefing, to optimize learning from these encounters.