Anger De-escalation: A Standardized Patient Workshop for Third- and Fourth-Year Medical Students

During clinical training, medical students frequently encounter angry patients and loved ones but feel inadequately prepared to de-escalate these encounters. This unpreparedness might contribute to feelings of shame and anger among medical students and burnout among practicing physicians. Challenging patient scenarios abound in the standardized patient (SP) literature, but no published didactic tool exists focusing exclusively on identification and nonpharmaceutical management of patient anger with a target audience of senior medical students.

We created a 2-hour SP-based communication workshop for senior medical students. Small groups of students and one SP role-played angry patient scenarios with themes commonly encountered by subinterns, which a single facilitator then debriefed. To assess session effectiveness, student participants (N = 311) completed a presurvey prior to the workshop and a postsurvey immediately after. One hundred ninety students also completed a summative postworkshop observed structured teaching exercise.

Comparison of pre- and postworkshop responses (254-259 paired-response items from 311 participants) revealed a statistically significant improvement in students' self-reported confidence in six metrics related to anger identification and de-escalation (p < .001). Students also demonstrated statistically significant improvement in their ability to appraise the utility of common phrases for managing patient anger (p < .001).

Equipping students with evidence-based communicative strategies like the NURSE mnemonic improves their confidence in angry patient/family encounters and helps them more effectively appraise appropriate communication strategies in those encounters. This workshop may protect against feelings of shame and anger and augment self-efficacy in students' transition to clinical duties.