Stanford medical student Genna Braverman, a member of the 2013 entering class, recently won "best poster" at the national meeting of the Society of Teachers of Family Medicine. The poster visually represented a qualitative analysis of nearly 800 written student reflections collected over the past seven years, describing communication challenges the students encountered when learning how to practice family medicine.
When I talked recently with Braverman about her work, she emphasized that it can be quite a challenge to convey qualitative work in a visually compelling, streamlined manner. But the subject matter is something she's always been interested in - interpersonal dynamics, the doctor-patient relationship, and communication issues were on her mind before medical school, and her interest intensified after she took courses in bioethics at Stanford.
Braverman enjoys a close relationship with her adviser, Erika Schillinger, MD, who she called an "amazing, inspiring mentor." Her interest was piqued after listening to Schillinger speak, and confirmed when they met and she learned of all their overlapping interests. Schillinger mentioned a large dataset of student reflections she was interested in analyzing, and Braverman thought the project sounded like just what she was hoping to spend her summer and fall working on.
About the findings, she told me, "In the written reflections, students overwhelmingly wrote about communication challenges that related to working with patients and their families, and the main themes we found were challenges in exchanging verbal information, navigating emotionally charged situations, and negotiating the terms of the encounter."
The poster represents only a portion of the entire research project's findings. In addition to these written responses, there was data collected afterwards from focus groups, in which the researchers found an interesting divergence. "Many, many more students discussed challenges communicating with other members of the healthcare team (particularly with their attending physicians) in the context of an evaluative environment," Braverman said.
So what do these results suggest should be done? Currently, communication curricula focus on the content and process of the medical interview, while psychodynamic factors - including those aspects of the encounter that are emotionally charged or conflicting - receive less time and energy. Schillinger is very interested in curricular reform early in medical school, and this research suggests that the sizable communications curriculum in the first two years should be reevaluated. Particular areas of interest might be agenda setting, use of interpreters, and time management
In her career, Braverman hopes to combine patient care, teaching, and research, and so she's pursuing academic medicine. She told me: "I find the variety of work appealing... I want a chance to work with patients directly but also to help advance the field. Teaching is very important to me."
Photo courtesy of Genna Braverman