Abstract

Delivering bad news without destroying hope: the conceptions, concerns and actions of physicians in India

Author(s): Lawrence Martis, Anne Westhues

Introduction: This qualitative study investigates the subject of ‘clinical communication’ and how it is taught, learned and practised in one London medical school and hospital. It is informed by theoretical perspectives from workplace learning.

Methods: Five clinical communication teachers and five fourth year medical students took part in a series of interviews and ward observations. Teachers were interviewed about their teaching practice; they were asked to observe students in the clinical workplace and were asked to reflect upon whether these observations had informed their teaching practice. Students were interviewed about how they had learned and subsequently practised clinical communication in the clinical workplace.

Results: Results suggest that teachers wished to develop a more authentic and integrated teaching practice focused on the clinical workplace. Students seemed able to apply the clinical communication skills they had been previously taught to the clinical workplace, but the patient centred philosophy underpinning these was lost.

Discussion: Conceptually, the research shifts focus to the clinical workplace as the legitimate location for teaching and learning clinical communication in the later years of the curriculum and proposes a new and expanded way of understanding learning in this context and ends by suggesting practical ways in which this could be achieved.