The First Steps Towards Professionalism? A Qualitative Study of Medical Students’ Experiences With Patients’ Emotional Issues During a Medical Interview

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Background: There is evidence that self-reported empathy decreases as medical students go through clinical training, but few in-depth studies have investigated students’ own experiences with empathy during medical interviews. We therefore wanted to explore this topic qualitatively by studying medical students’ perceptions, experiences, and reflections during communication with patients expressing emotional issues in an arranged medical interview. Methods: A qualitative content analysis of semi-structured interviews with third year medical students (N=11) was conducted using video-stimulated recall from their own medical interview with a simulated chronically ill patient. Students were led to believe that the patient was real. Results: Six themes which may influence student empathy during history-taking were identified through analysis of interview data: (1) Giving priority to medical history taking, (2) Interpreting the patient’s worry as lack of medical information, (3) Conflicts between empathy and professional identity, (4) Empathy as a technical communication skill, (5) Striving for a professional form of empathy and (6) Disagreements on whether communication of empathy must be heart-felt. Conclusions: The participating students described conflicts between a medical agenda, rules and norms for professional conduct and the students’ own judgments when trying to empathize with the patient. Educators should actively encourage group discussion and reflection on these underlying conflicting norms and values as part of the formal curriculum, and consider possible side-effects of the medical curriculum, including the communication skills teaching, on students’ empathy.