Authors: Isaac Alty, MD; Luis Guilherme Cardoso; Michael Kochis, MD, EdM; Ashwini Joshi

Editor: Wesley Chou, Andrew Foley, MPH, and Joyce Zhou​

Reviewers: Aliya Feroe; Andrea Wershof Schwartz, MD, MPH; Catherine Mankiw; Jocelyn Streid, MD, MPP; Kate Treadway, MD; Katie Greenzang, MD, EdM

Introduction

As future physicians, we must master not only the science of medicine but also its art. Module 4 discusses the pandemic's tremendous psychological trauma on society: while not everyone will become infected with SARS-CoV-2, during a pandemic, everyone is affected in some way. The art of medicine involves bringing that recognition to our encounters with friends and family, as well as to patients in direct clinical settings. Physical distancing measures impose new realities on what interacts look like. Furthermore, misinformation surrounding this pandemic has promulgated rapidly and guidelines have changed dramatically over the span of months. Adapting to these changes presents the perfect opportunity to review communication skills that will serve us well in this uncertain time.

Additionally, there is a renewed sense of urgency surrounding conversations on advance care planning (ACP), given the disproportionate burden of COVID-19 on the elderly and those with serious illness. While medical students may not always spearhead these challenging conversations, they can play a critical role in prompting busy care teams to discuss ACP with patients. Thus, familiarizing themselves with what ACP entails and frameworks for approaching it are certainly relevant to every medical student’s education.

We’ve now discussed Brian and Diane in the context of their medical and mental health risk and why our community benefits from collective physical distancing. But knowing the facts is only a small part of effective engagement. In this module, we pivot to developing concrete tools that can help us communicate effectively with individuals like Brian and Diane.

Think of the people in your own life who may be struggling in similar ways to Brian and Diane. What makes communicating with them challenging, and how may you try to understand or support them differently?

Learning Objectives

At the end of this module, medical students should be able to:

• Revisit 3 key conceptual frameworks for communication skills and recognize the tool that would be most appropriate for a given situation

• Review methods through which to manage patient's questions about the COVID-19 and the reliability of information around the disease, as well as large divergences in opinion

• Rehearse serious conversations with patients pertaining to bad news, misinformation, and advanced care planning.

• Identify ways in which a person's lived experiences may shape their current views towards the pandemic and use that to better inform methods by which to motivate them to modify behaviors.

Core Materials

• Stone, Patton, and Heen, “Difficult Conversations,” Introduction and Chapter 1.

• VitalTalk, COVID-ready communication skills.

• Recommended Activity: Tamerius and Campt, “Your Angry Uncle Wants to Talk About Politics. What Do You Do?” New York Times Opinion.

• Patient-friendly infographic: COVID-19: What you need to know: a 1-page guide (last updated April 2020)

  • Patient-friendly resource from UpToDate (last updated September 2020)

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