The stories they tell: How third year medical students portray patients,family members,physicians, and themselves in difficult encounters

Background: Physicians have long had patients whom they have labeled “difficult”, but little is known about how medical students perceive difficult encounters with patients.

Methods: In this study, we analyzed 134 third year medical students’ reflective essays written over an 18-month period about difficult student–patient encounters. We used a qualitative computerized software program, Atlas.ti to analyze students’ observations and reflections.

Results: Main findings include that students described patients who were angry and upset; noncompliant with treatment plans; discussed “nonmedical” problems; fearful, worried, withdrawn, or “disinterested” in their health. Students often described themselves as anxious, uncertain, confused, and frustrated. Nevertheless, they saw themselves behaving in empathic and patient-centered ways while also taking refuge in “standard” behaviors not necessarily appropriate to the circumstances. Students rarely mentioned receiving guidance from attendings regarding how to manage these challenging interactions.

Conclusions: These third-year medical students recognized the importance of behaving empathically in difficult situations and often did so. However, they often felt overwhelmed and frustrated, resorting to more reductive behaviors that did not match the needs of the patient. Students need more guidance from attending physicians in order to approach difficult interactions with specific problem-solving skills while maintaining an empathic, patient-centered context.     

Identifying a context-effective school hearing screening test: An emic/etic framework

Objective: To identify a context-effective hearing screening test for primary schools in the Western Cape, South Africa using an emic-etic framework for test selection. Design: A sequential mixed methods design was used to: (1) Identify test properties needed to successfully screen hearing in primary school children in the Western Cape, (2) select the hearing screening test most likely to succeed in this context, and (3) assess the use of the test in context. Study sample: Three nurses, two nursing assistants, two paediatric audiologists, and 100 grade-one children participated. Results: Distortion product otoacoustic emissions (DPOAEs) were identified as the test most likely to succeed as a hearing screening test in primary school children in the Western Cape. While school nurses were able to successfully apply OAE testing in this context, its sensitivity to hearing loss in these children was 57.14%. Conclusions: The sensitivity would need to be improved before OAE testing could be used as a context-effective screening test for primary school children in the Western Cape. The study demonstrated the value of collaborative program planning using an emic-etic framework to ensure that screening tests are contextually appropriate.     

Assessing the clinical significance of treatment outcomes for distressing voices in routine clinical practice

Determining reliable and clinically significant change is central to evidence‐based practice yet rarely used in routine clinical settings. This paper illustrates these methods in the context of an evaluation of cognitive behaviour therapy for distressing auditory hallucinations (“voices”). We used data from a clinical sample attending Perth Voices Clinic, a transdiagnostic outpatient service for distressing voices, and a previously published reference sample of healthy voice hearers. Our outcomes on the primary measure of voice distress, derived from a previous factor analysis of the Psychotic Symptom Rating Scale‐Auditory Hallucinations subscale, showed that 62.9% of clients were classified as Recovered/Improved, 35.5% were classified as Unchanged, and 0.02% were classified as Deteriorated. Partial support for the validity of these classifications was obtained from the scores on the Depression, Anxiety, Stress Scales (Lovibond & Lovibond, 1995) but not on the Social and Occupational Functional Assessment Scale (Goldman et al., 1992). Clients classified as Recovered showed better emotional functioning on the Depression, Anxiety, Stress Scales compared with those who did not make a clinically significant change in voice distress. A tool is provided to assist practitioners to evaluate whether individual clients have benefited from therapy for distressing voices or not, which can be used to guide future treatment decisions ( https://osf.io/gd9e5/ ).     

Die Spezialambulanz für Borderline-Störungen an der Universitätsklinik für Psychoanalyse und Psychotherapie

Psychotherapie Forum - In dem Beitrag wird einleitend die Geschichte der Entstehung der Spezialambulanz für Borderline-Störungen an der Universitätsklinik für Psychoanalyse und...     

From clock to functional pacemaker

In mammals, the central pacemaker that coordinates 24‐hr rhythms is located in the suprachiasmatic nucleus (SCN). Individual neurons of the SCN have a molecular basis for rhythm generation and hence, they function as cell autonomous oscillators. Communication and synchronization among these neurons are crucial for obtaining a coherent rhythm at the population level, that can serve as a pace making signal for brain and body. Hence, the ability of single SCN neurons to produce circadian rhythms is equally important as the ability of these neurons to synchronize one another, to obtain a bona fide pacemaker at the SCN tissue level. In this chapter we will discuss the mechanisms underlying synchronization, and plasticity herein, which allows adaptation to changes in day length. Furthermore, we will discuss deterioration in synchronization among SCN neurons in aging, and gain in synchronization by voluntary physical activity or exercise.