Concerning Confidence: Serious Illness Conversations During the Medicine Acting Internship

Background: Despite increased recognition that physician–patient communication represents a key competency for medical trainees, relatively little is known about student exposures to conversations about serious illness. Objective: To characterize student experiences with multiple types of serious illness conversations during their medicine acting internship (AI). Design: This is a cross-sectional survey. Setting/Subjects: Final-year medical students who had completed a medicine AI within one year at one U.S. medical school. Measurements: Exposures to and perceptions of multiple conversation domains (discussions with upset patients/families, breaking bad news, assessing code status, and conversations about limiting or withdrawing life-sustaining treatments). Results: We collected 82 survey responses (78% response rate). Students reported multiple exposures across most domains, some of which included leading conversations without supervision or formal instruction. In most domains, at least 50% of students reported confidence in their ability to lead unsupervised conversations moving forward. Conclusions: After a four-week AI, students reported multiple exposures to a variety of serious illness conversations. Some reported having these conversations without supervision. Student confidence in their ability to lead these conversations independently was higher than has been previously reported in other small studies. Further exploration is required to better understand these trends, and targeted curricular development may be indicated.