Cultivating patient-centered care skills through engagement in difficult conversations

Appropriately engaging with patients around sensitive, challenging, or uncomfortable topics, often termed "difficult conversations," is a facet of patient-centered care. Development of such skills prior to practice often occurs in the hidden curriculum. Instructors implemented and evaluated a longitudinal simulation-based module aimed at advancing students' understanding and abilities to use patient-centered care skills to navigate difficult conversations within the formal curriculum.

The module was embedded within the third professional year of a skills-based laboratory course. Four simulated patient encounters were revised to increase opportunities to practice patient-centered skills during difficult conversations. Preparatory discussions and pre-simulation assignments delivered foundational knowledge, and post-simulation debriefing allowed for feedback and reflection. Students completed pre- and post-simulation surveys to measure understanding of patient-centered care, empathy, and perceived ability. Instructors assessed student performance in eight skill areas using the Patient-Centered Communication Tools.

Of 137 students, 129 completed both surveys. Students' definitions of patient-centered care grew in accuracy and detail following module completion. Eight of the 15 empathy items were significantly changed from pre- to post-module, signifying enhanced empathy. Student perception of ability to perform patient-centered care skills significantly improved from baseline to post-module. Across the semester, student performance on simulations significantly improved on six out of eight patient-centered care skills.

Students deepened their understanding of patient-centered care, grew in aspects of empathy, and improved actual and perceived ability to deliver care that is patient-centered during challenging encounters.