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Discrimination and bias in clinical training often take the form of microaggressions, which, albeit unintentional, are detrimental to the learning environment and well-being of students. Although there are a few reports of medical schools training students to respond to microaggressions, none have included a complementery student-led faculty training module. The aim of this study was to develop and evaluate a case-based approach to improving student resilience and increasing faculty awareness of microaggressions in the clinical setting.We created four realistic cases of microaggressions and uncomfortable conversations, based on students' experiences on the wards, to implement training for incoming third-year students and their core faculty. Standardized patients were trained to effectively portray discriminatory faculty, residents, and patients. Institutional review board-approved surveys were administered and statistically analyzed to evaluate for efficacy.Students had greater mean confidence scores for responding to microaggressions immediately and at 6 months after the sessions (This approach had results similar to other studies, with the additional benefit of training faculty with the same scenarios. We believe that this method helped bridge the gap between students' notions of discrimination and faculty understanding of microaggressions.

HIGHLIGHTS: CCS training lacks a formal structure with substantial variation of the teaching process. The interviews promoted, amongst important stakeholders, a rise in awareness of this situation and how these skills can enhance the quality of clinical practice, encouraging curricular change. A communication skills teaching model: CoSTProMed is suggested for curriculum integration. BACKGROUND: The importance of clinical communication skills (CCS) teaching and assessment is increasingly recognized in medical education. There is a lack of outcome-based research about CCS teaching and assessment processes in Portuguese medical education. Our goal is to conduct a SWOT analysis of this process in Portugal, Angola and Mozambique in order to contribute to the establishment of an action plan for more effective CCS teaching and assessment in medical curricula. METHODS: Between 2010 and 2012, semi-structured interviews focused on the state of the art of teaching and assessment of clinical communication skills were conducted with key stakeholders of medical courses in Portugal, Angola and Mozambique. The design corresponds to an exploratory, descriptive and cross-sectional study, with the analysis of the recorded interviews. Interview transcripts were analyzed to identify salient themes/coding template in their discussions of the CCS teaching process. The coding and analysis of the surveys is qualitative. RESULTS: 87 interviews were performed at the 8 Portuguese, 1 Angolan and 1 Mozambican medical schools. Results indicate that the teaching and assessment process of CCS is in the beginning stages with these commonalities noted: (i) Variability amongst faculty in the teaching and assessment methods, (ii) disconnection of CCS between basic and clinical cycles, (iii) content and process skills and (iv) faculty development. CONCLUSIONS: CCS training lacks a formal structure with considerable variation of the CCS teaching process in these countries. The interviews promoted a rise in awareness of this situation and how these skills can enhance the quality of curricular change. Some important opportunities for the development and implementation of a framework of an integrated communication skills curriculum such as curricular reforms and well-established cooperation and networks were identified. The acknowledgement of the importance of integrating these skills in ME by key stake-holders and students in institutions and the identification of champions motivated to commit to the effort are strengths that should be considered to integrate and enhance CCS in the medical curricula.

Introduction This workshop was designed as an instructional tool to foster development of the nondirective pregnancy options counseling competency, a competency identified as a “does” level for third-year medical students by the Association of Professors of Gynecology and Obstetrics in the ninth edition of its curricular objectives. Methods The workshop consists of three modules that may be conducted independently or in combination with small or intermediate-sized groups of medical students. All the modules use challenging reproductive health scenarios as case material. The first module begins with two short trigger videos followed by structured discussion to provide an introduction to the core ethical issue of conscientious refusal, the limits of conscientious refusal in providing quality health care, and the connection between ethical breaches and errors in communication skills. The second module consists of a private values clarification exercise that may be further augmented with discussion. The third module uses the “helping trios role-play” technique to allow learners to practice the handling of ethical conflict with patients seeking objectionable medical interventions. Results The workshop was used in our obstetrics and gynecology clerkship over 3 academic years with more than 300 students. In anonymous pre- and postworkshop questionnaires with 140 students, participants reported heightened self-awareness after participation, with 95% rating the exercise as educationally valuable and 84% reporting that they would approach patient care situations differently in the future as a result. Data showed improvement in some parameters of options counseling competency and overall improvement in verbal and nonverbal communication skills. Discussion This 3 part session is intended to teach the ethical reasoning for professional handling of conscientious refusal and prepare students to maintain professionalism when finding themselves with ethical objection to a medical intervention that a patient requests or may need. Facilitators should be versed in patient centered communication and the American College of Obstetricians and Gynecologists Ethics committee opinion, competent in small and/or intermediate sized group facilitation skills, and facilitation of helping trios (for part 3 only.) Each part may stand alone as a separate exercise and/or small group discussion.

Objective This study evaluates an educational intervention focusing on the ethical reasoning and communication skills necessary in counseling patients about morally objectionable medical interventions. Study Design All students on the core clerkship in obstetrics and gynecology at the University of Miami Miller School of Medicine participated in a structured workshop. Students completed anonymous surveys before and after the workshop. Associations between the participants' change in comfort level in providing nondirective counseling and measured demographic variables were analyzed. Results Of 140 students, 37% (n = 52) positively changed their comfort level with nondirective options counseling; 10% (n = 14) negatively changed. Change in understanding of the physician's role was reported by 60% (n = 84). The exercise was rated as educationally valuable by 95% (n = 128), with 84% (n = 115) attesting that the workshop would help them “approach things differently.” Conclusion Evaluation of multiple parameters demonstrated that this workshop heightened student awareness of the ethical and communications skills challenges posed by this clinical situation.