Emotional responses from medical students provoked by professionalism issues in simulated primary care consultations

Problem

Professionalism issues can be a challenge for students. How they deal with these early on in their careers is important. Learning from emotions can play a vital part in professional development. Professionalism forms a key component of the undergraduate curriculum. Primary care provides a unique place to teach professionalism. The King’s Undergraduate Medical Education in the Community Team have a highly rated simulated primary care teaching programme for third year medical students. We took advantage of this setting to explore emotions and feelings of students provoked by professionalism issues in simulated primary care consultations to help facilitate and maximise students learning.

Approach

Simulated primary care consultations with embedded professionalism prompts were conducted with third year medical students. The prompts included a ‘flirty patient’ and a patient giving a monetary gift in a consultation. Consultations were supervised by a general practitioner (GP tutor) and each consultation was observed by up to four students. Students’ reactions, responses and emotions expressed to professionalism prompts were observed remotely. Focus groups with students and a focus group with GP tutors exploring their views of the value of the simulation and feelings towards professionalism content were audio-recorded. Recordings were transcribed verbatim and anonymised. Data were thematically grouped, coded and reviewed by co-authors using a framework approach.

Findings

Fifteen simulation consultations were observed. Two student focus groups of eight and seven students and one focus group of seven GP tutors were conducted. Students commented on feeling embarrassed and being shocked by the unexpectedness of professionalism issues. They expressed this by being shy, blushing or more commonly laughing during the consultations. Humour expressed by students during the consultations was not commented on by the tutor. Some felt stressed by the situation and this led to a negative experience. Despite this, they appreciated the opportunity to practice with challenging professionalism issues. Some felt a sense of guilt and were apologetic when patients were challenging their professionalism.

Consequences

The range of emotions expressed demonstrates that students were immersed and engaged in the simulated consultations. Positive experiences and emotions can create memorable learning experiences for students and therefore contribute to translation learning (or professional development). Simulated consultations are a good way to prepare students for the unexpected nature of work in primary care. It is important for tutors and educators to raise professional behaviours and emotions in a safe learning environment. We propose that finishing simulated consultations with positive experiences may facilitate learning. Finishing consultations when embarrassed or shocked may make learning difficult. We believe this work will impact positively on scenario writing for future sessions. Highlighting emotions expressed and observed by students may encourage deeper learning as part of the hidden curriculum.