Medical students want more support with challenging patient interactions

Like physicians, medical students sometimes experience frustration and other negative emotions when interacting with patients. These patients are often labeled as “difficult”—they’re angry or aggressive, challenge or decline clinicians’ recommendations, or make what are seen as irresponsible health decisions. Patients labeled as difficult have lower quality interactions with doctors, which is linked to poor health outcomes.

The importance of these interactions make them a valuable focus for clinicians and in medical education. New Bixby Center research looks at this issue through a new lens, talking to medical students about the strategies they use and the support they want to succeed. The researchers found five major themes for how students deal with this difficult interactions:

  • Finding empathy or compassion. Students talked about consciously focus on putting themselves in the patient’s shoes and striving to understand their perspective. Many of the students noted the importance of considering structural determinants of health and how they would impact the patient’s behavior.
  • Communication strategies. Students deploy strategies like asking open-ended questions to elicit a patient’s concerns and spending extra time with them.
  • Anticipating challenging interactions. Students would sometimes go in setting expectations for hard interactions. However, warnings about particular patients negatively influenced them before they got a chance to get to know the patient.
  • Seeking support. Students would seek out other people to discuss the experience with, often what one student called “real life people,” or people outside of medicine.
  • Taking responsibility. Some students chose to view this challenge as a chance to be independent and to be seen as the patient’s physician.

Students generally described feeling that they often didn’t know how to handle these interactions. They offered ideas for formal and informal teaching opportunities to help them navigate dealing with difficult patients. These included more lectures on social and interpersonal topics, support groups, checking in before and after patient interactions and better preparing faculty to teach on these topics.  

To help address these needs, Innovating Education in Reproductive Health has developed an interactive tool for exploring feelings around challenging patient interactions. 

Challenging patient interactions are common. Physicians label roughly 20% of their patients as “difficult.” If programs elevate emotionally challenging patient interactions to the same level as other clinical issues that must be taught to students during training, they can use the same techniques and cognitive apprenticeship models that are already familiar to health professions educators. It’s critical to help clinical learners develop effective strategies to navigate these interactions and develop emotional self-awareness to prepare them to provide high-quality care in the future.