Technology Triggers for Caring: Examining Affect While Learning to Communicate Bad News to Patients

• In Event: Knowing What Students Know and Feel: Innovative Technology-Rich Assessments

Abstract

Objectives: All students need to learn to monitor and manage their emotions in academic settings. However, medical students must manage both their own emotions as well as their patients’ emotions when communicating bad news. We explore how technology can serve as a trigger for medical students to care about their patients while communicating bad news. We designed a technology rich learning environment that connects medical students and facilitators in Canada and Hong Kong to explore these issues. Our objective is to examine how students from different cultures consider the role of affect in communicating bad news to patients.

Theoretical Framework: Our instructional framework is a case-based approach where cases serve as the instructional content. Case based learning helps individuals develop skills of critical analysis, problem solving, and confidence when guided with appropriate feedback (Derry & Hmelo-Silver, 2005; Kolodner, et al., 2006). In medicine, cases can be incorporated into a problem based learning approach where students direct their own learning within small groups in which facilitators help guide the learning process (Hmelo-Silver & Barrows, 2006, 2008).We explore student affect by examining self-efficacy (Bandura, 1995) and achievement goals (Pintrich et al., 1991) as well as the emotional content of discourse.

Methods: A case study approach is used to describe student learning and affect during a week-long on-line course on communicating bad news. Pre/post tests of self-efficacy, motivation, and performance were administered on-line. The intervention consisted of two PBL sessions with two cases administered using adobe connect. Four medical students (2 from each country) worked together synchronously on PBL video cases. One case was created in Canada and facilitated by a Canadian, the other case created and facilitated by a Hong Kong physician. Pre and post performance measures were conducted using adobe connect where the students practiced communicating bad news with international standardized patients.

Data sources: Data were collected on individuals as well as PBL groups. New assessment rubrics were created to score performances. Discourse analyses included content analyses of the knowledge used to communicate bad news. The international PBL group discourse examined the group dynamic over cases, how students came to recognize the important learning issues when communicating bad news, and how they attended to cultural and emotional differences in the technology triggers that supported video-based cases.

Results: The pre/post test data reveal positive changes in students self efficacy. Video analysis of student performance with standardized patients indicated a dramatic change in recognizing how best to communicate bad news. The case study supports several types of data analyses. Pre-post test measures address students’ motivation and ability to identify the important aspects of physician-patient communication. The instructional discourse reveals differences in the type of affective content considered pertinent to each case, cultural differences, and instructor facilitation.

Scientific significance: Medical students are taught to regulate emotional variables pertinent to patient care. This research provides evidential support for extending the learning, assessment and instruction triad to include affective variables that will expand our understanding of how the heart and mind intersect while solving complex problems.

Authors

• Susanne P. Lajoie, McGill University

• Jingyan Lu, The University of Hong Kong

• Cindy E. Hmelo-Silver, Rutgers University

• Ilian Cruz-Panesso, McGill University

• John Ranellucci, McGill University

• Jeffrey Wiseman, McGill University

• Lap Ki Chan, University of Hong Kong