Can we teach students how to communicate?

This week at CEEP rounds, a project was presented on teaching medical students and residents how to have code status discussions with patients and their families. The lead on the project developed three different videos that focused on the “right” way to have a discussion, reinforcing areas such as encouraging patients to tell you about their perceptions of their health, addressing their own preconceived notions, and allowing time to have further discussions on the topic.

In my opinion, the project has immense potential and definitely addresses a need. I vividly recall the first time I was asked by my senior resident to “get the code status” from an elderly patient admitted for shortness and breath and hypercalcemia related to progression of mesothelioma. I stumbled through the discussion and came out of the room having reached a consensus that he would be “full code”. I could see the look of disappointment on my senior’s face when I told her the news.

Reflecting on the situation, I know I could have had a more meaningful conversation with him. I also know now that perhaps 3 am in the emergency room was not the ideal time to have the code status discussion. Obtaining code status is not taught to medical students in our current curriculum despite having to do it routinely on the internal medicine CTU service. We are taught how to break bad news (which we almost never do as clerks) with small group learning, mock situations and standardized patients. I think that there is a definite need for more teaching at the undergraduate level on how to effectively and empathetically have these difficult conversations, not just isolated to code status but in other areas as well (such as obtaining consent which I have also found to be personally challenging).

At the end of the presentation, Dr. Panisko asked a very thought provoking question: Can we truly teach communication? Or is it a process learned best through personal experiences and learning in the clinical setting? The question is hard to answer. Certainly, in the curriculum, students have found value in being taught how to break bad news, whether through small group discussions or practicing with standardized patients. It’s hard to know though if this value is translated into tangible skills in the clinical setting. Nonetheless, I still think it’s worthwhile to continue to develop novel ways to teach these sorts of communication skills to medical students and residents, whether through one-on-one mentoring with an experienced physician, practicing with classmates or standardized patients, or perhaps even one day learning through videos or online modules.

-Carolyn