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Objectives This qualitative study aimed to investigate communication about death in consultations with patients undergoing chemotherapy with no curative intent. Specifically, we examined (i) how the topic of death was approached, who raised it, in what way, and which responses were elicited, (ii) how the topic unfolded during consultations, and (iii) whether interaction patterns or distinguishing ways of communicating can be identified. Methods The data consisted of 134 audio-recorded follow-up consultations. A framework of sensitizing concepts was developed, and interaction patterns were looked for when death was discussed. Results The subject of death and dying was most often initiated by patients, and they raised it in various ways. In most consultations, direct talk about death was initiated only once. We identified 4 interaction patterns. The most frequent consists of indirect references to death by patients, followed by a direct mention of the death of a loved one, and a statement of the oncologists aiming to skip the subject. Significance of results Patients and oncologists have multiple ways of raising, pursuing, addressing and evacuating the subject of death. Being attentive and recognizing these ways and associated interaction patterns can help oncologists to think and elaborate on this topic and to facilitate discussions.

OBJECTIVE To investigate how medical students' empathy is related to their mental health and burnout. METHODS This cross-sectional study included 886 medical students from curriculum years 1-6. The cognitive, affective, and behavioural dimensions of empathy were measured with self-report questionnaires and an emotion recognition test. Regressions were used to test the relationship between the empathy dimensions, depressive symptoms, anxiety, and burnout as well as the influence of curriculum year and gender. RESULTS Cognitive and behavioural empathy were significantly related to less mental health issues and burnout, whereas affective empathy was related to more mental health issues and burnout. Students in later curriculum years reported less mental health issues and burnout than students in earlier years, whereas no systematic difference could be observed for empathy. Female students reported more mental health issues and burnout as well as higher empathy, except for behavioural empathy for which male students scored higher. CONCLUSIONS The cognitive, affective, and behavioural dimensions of empathy were differently related to the mental health and burnout of medical students. Students presenting mental health issues or burnout might have more difficulty to adapt their behaviour in social situations and keep a certain distance when taking others' perspective.

Objectives This study aimed to explore in a naturalistic, real-life setting the dynamics of trust in oncological consultations. Methods Cases to study were purposively selected from a data set of audio-recorded and transcribed consultations between oncology physicians and patients with advanced cancer, and analyzed qualitatively. The analytical approach was deductive, relying on a thematic framework of dimensions of trust, and inductive, not restricted by this framework. Results The multiple case study approach allowed to identify factors, which play a role in the dynamics of trust. These factors are the number of treating physicians and how they communicate, continuity of care and the capital of trust, the hierarchical position of the physician and the physician's self-trust, and the patient's personality. Significance of results The findings illustrate the importance to contextualize trust in the flow of oncological consultations and to conceive it comprehensively for each singular encounter between patients and clinicians.

COMME NOUS LE RAPPELLE le contenu d’un article paru dans le dernier numéro du Journal of Sociolinguistics, la communication entre cliniciens et patients est encore loin de se réaliser toujours et partout dans le plein respect de ce qu’il est convenu d’appeler la dignité des personnes. Certes, la question de la dignité des personnes interroge plusieurs aspects de la relation thérapeutique. Le fait de comprendre et d’être entendu constitue à l’évidence l’un d’entre eux. De ce point de vue, une part importante de la population migrante et allophone apparaît clairement désavantagée. On pense particulièrement aux migrants primo-arrivants qui fréquentent de manière importante – du moins en Europe et en Amérique du Nord – les structures de santé. Une fréquentation qui s’explique pour une large part par la situation de vulnérabilité que peuvent, par exemple, engendrer un statut administratif précaire, de faibles ressources socioéconomiques et des traumatismes vécus dans le pays d’origine. Dans le monde médical, comme ailleurs, la réussite des échanges verbaux suppose un partage, d’une part, des codes communicationnels utilisés dans ces échanges et, d’autre part, d’un certain nombre d’implicites culturels permettant de décrypter correctement le sens plein de tel ou tel message. La notion de « barrière linguistique » est souvent convoquée pour rendre compte des situations de nonpartage ou de partage très limité de ces codes et implicites. Cependant, cette notion et les réalités qu’elle devrait recouvrir apparaissent encore trop peu problématisées.

AS AN ARTICLE THAT APPEARED IN THE CURRENT ISSUE of the Journal of Sociolinguistics reminds us, communication that fully respects what is now commonly known as human dignity is far from being present between health providers and patients in all settings and everywhere in the world. Evidently, the question of human dignity raises questions about several aspects of the clinician-patient relationship, among others the aspect of understanding and being understood. At this regard, many migrants with native languages different to those spoken in their host country are at a particular disadvantage. This becomes obvious especially as concerns the newly arrived migrants in Europe and North America that visit frequently health facilities. This high frequency may be explained by their vulnerability as a possible result of their often problematic administrative status, low socioeconomic resources or past trauma experience in their countries of origin. Both in the medical domain and elsewhere, the success of verbal communication presupposes, on the one hand, mutual communication codes that are used for interaction and, on the other hand, a number of cultural implicits that facilitate the correct decoding of the full meaning of a given message.

L’APPROCHE COMMUNAUTAIRE COMPTE parmi les moyens mis en œuvre pour permettre aux migrants allophones d’accéder pleinement aux systèmes de soin dans un certain nombre de pays, essentiellement occidentaux. Cette approche qui veut que l’agent de santé s’exprime dans la langue première du « patient » migrant est précisément celle qu’a soutenue en Suisse l’Office Fédéral de la Santé Publique (OFSP) s’agissant de la prévention du VIH/sida auprès des migrants d’origine subsaharienne (OFSP, 2010a). Au travers des résultats d’une étude récente (Singy & Guex, 2008), la présente contribution vise au questionnement de certains des fondements de l’approche dite communautaire en regard du profil de ceux qu’elle vise à prévenir.

Countertransference towards suicidal patients may blur healthcare professionals’ clinical judgment and lead to suboptimal decision-making. We conducted a systematic review of the quantitative studies on this topic. Following PRISMA guidelines, various databases were searched for studies measuring countertransference in healthcare professionals treating suicidal patients. Two authors independently performed screening and the quality of included studies was formally assessed. Ten studies were identified (3/5/2 of low/intermediate/high quality, respectively). Cross-sectional studies showed evidence for specific and adverse countertransference (e.g., disinterest, anxiety, overwhelming, rejection, helplessness or distress) towards suicidal patients. Furthermore, countertransference was prospectively associated with suicidal behavior and ideation in studies that explored this issue, but the meaning of this association remains to be clarified. Healthcare professionals’ characteristics (e.g. professional background, gender, personality traits) influenced countertransference. Suicidal patients elicit adverse countertransference, which should be addressed in clinical practice and through dedicated training.

ObjectivesWhile patients’ symptom experiences have been widely investigated, there is a lack of contextualized studies investigating how symptoms circulate in the medical consultation, how patients present them, what they convey, how physicians respond, and how patients and physicians negotiate with each other to find ways to address them. The aim of this study is to explore patients and physicians handling of symptoms throughout oncological consultations with a multiple case study approach.MethodsFive consultations, purposively selected from an existing dataset of audiotaped consultations with patients with advanced cancer, were analyzed by means of an inductive analytical approach based on a sensitive framework from the literature.ResultsPatients’ symptoms showed multiple dimensions such as medical, cognitive, emotional, psychological, interactional, symbolic, experiential, and existential.Significance of resultsDifferent symptom dimensions remained unnoticed and unaddressed in the consultations. The physician-centered symptom approach that was observed leads to consumed time and missed opportunities for relationship building with the patient. Physicians showed a lack of sensitivity regarding the multiple dimensions of symptoms. Based on the findings, strategies for a more comprehensive symptom approach can be conceived.

Background Previous findings showed that suicidal patients elicit mostly negative countertransference such as distress, hopelessness, feelings of inadequacy, and apprehension, and that a concurrent personality disorder is associated with more feelings of entrapment and mistreatment, among other adverse reactions. No studies were however conducted on instant countertransference (iCT), i.e., after a single encounter, for example in an emergency setting. We aimed to evaluate the impact of suicidal ideations, self-harm and presence of personality disorders on instant Countertransference (iCT). Methods Caregivers rated their iCT with two validated and standardized questionnaires after a first emergency or outpatient consultation. Suicidal ideation, self-harm and personality disorders were tested as predictors for iCT in a multivariate and multilevel analysis. Results Thirty caregivers rated their iCT towards 321 patients. Personality disorders and suicidal ideation, but neither recent nor past history of self-harm, predicted iCT. Common iCT included tension, lack of self-confidence and feeling of being tied. iCT specifically associated with suicidal ideation included distress, lack of hope, confusion, and sense that the patient's life had little worth. In contrast, iCT towards patients with personality disorders suggested tension in the therapeutic relationship (low affiliation with patient, anger, disappointment, devaluation). Limitations Caregiver's characteristics were not considered in the analysis. Furthermore, while countertransference also includes unconscious phenomena, only conscious iCT was assessed. Conclusions Patients with suicidal ideation and personality disorders elicit common but also specific negative iCT. Mental health institutions need to devote specific resources (such as clinical supervision and training) to help caregivers manage their iCT.

This investigation was based on 216 dreams of medical students about situations of evaluation. The manuscript reports on (i) how these situations are dreamt and what this reveals about dreaming students’ subjectivities, and (ii) the psychodynamic approach taken for the investigation of the dreams. Dreams were analyzed with a data-driven method based on three inter-related psychodynamic dimensions appearing in the dreams: quality of internal objects of the dreamer, intensity of the dreamer’s defensive stance and narcissistic impact of the evaluation situation on the dreamer. Presence or absence of good enough internal objects determined intensity of the defensive stances and the narcissistic impact. For some dreamers, the dreamt evaluation situation appeared as a catastrophic event associated with very negative experiences (e.g., feelings of despair and desire to die), despite the massively erected defenses (e.g., immature defenses like projection); inner objects appearing in the dreams of these students showed important deficits (e.g., abandon or rejection of the dreamer). This investigation of dreams revealed, that the issue of evaluation is very sensitive and represents for some of the medical students a major narcissistic threat. The psychodynamic approach chosen to approach the dream seem to be coherent, in line with psychodynamic dream research and allows to gain some insight into medical students’ subjectivities with regard to the omnipresent issue of evaluation., International Journal of Dream Research, Vol 15, No 1 (April 2022)

Bio-Psycho-Social Needs Assessment in Family Medicine: Acceptability of the Intermed Self-Assessment

This series of three articles presents the evolutions of (1) the clinical activities of psychiatric liaison, illustrated by the PENbank project, (2) the training provided by psychiatric liaison clinicians, described by a recently developed clinician-centered supervision, and (3) research in psychiatric liaison, exemplified by four studies. Because it goes beyond traditional types of liaison interventions for clinicians, the PENbank may be considered a meta-liaison project. Indeed, the PENbank is an infrastructure (a data bank), which allows to collect, store on a long-term basis, and use physicians' narratives of experiences.Cette série de 3 articles présente les évolutions de: 1) la clinique de la liaison psychiatrique, illustrée par le projet PENbank; 2) la formation par la liaison psychiatrique, au travers de l’exemple du développement d’un format de supervision centré sur les clinicien·nes et 3) la recherche en liaison psychiatrique, mise en lumière par 4 recherches récentes. La PENbank peut être comprise comme un projet de méta-liaison en ce qu’elle dépasse les formes traditionnelles d’intervention auprès des clinicien·nes et de soutien de l’activité clinique. En effet, la PENbank est une infrastructure (une banque de données) permettant le recueil et le stockage à long terme des récits d’expérience de médecins, ainsi que leur utilisation à différentes fins (visibilisation, restitution, recherche).

Liaison psychiatry consists of an activity of consultation for patients affected by somatic diseases and of an activity of liaison for clinicians. The liaison work can take different forms, such as teaching of patient-physician relationship, supervision or support. To illustrate psychiatric liaison research, we present four studies conducted in our service, which explore (a) the relations between medical students' mental health and their interpersonal competence, (b) the dreams of medical students and what they reveal of their subjectivities, (c) the stakes for primary care practitioners when asking for a specialist's consult, and (d) the situated clinical practice. These studies contribute to nourish psychiatric liaison, which can use their results for training or support of clinicians.La psychiatrie de liaison comprend une activité de consultation auprès des patient·es en soins somatiques et une activité de liaison auprès des clinicien·nes. La liaison psychiatrique peut prendre des formes diverses, tels l’enseignement de la relation soignant·e-soigné·e, des supervisions ou le soutien d’équipe. Dans cet article, nous présentons 4 études menées dans notre service qui s’intéressent : a) aux liens entre la santé mentale des étudiant·es en médecine et leurs compétences interpersonnelles ; b) à leurs rêves et à ce qu’ils révèlent de leur subjectivité ; c) aux enjeux de l’appel aux spécialistes pour les médecins de premier recours et d) à la pratique clinique en situation. Ces études contribuent à nourrir le travail de liaison qui peut s’appuyer sur leurs résultats dans la formation et le soutien des soignant·es.

In Switzerland, psychiatrists sometimes assume the role of gatekeepers when patients request assisted suicide, evaluating the patient's discernment and the existence of a possible psychiatric disorder interfering with the capacity to discern. Our study explores the motifs of requests for assisted suicide made by patients hospitalized in a somatic service of Lausanne University Hospital and the challenges faced by the psychiatrist as gatekeeper. We conducted a retrospective analysis of psychiatric reports concerning 18 patients aged 65 years or older who had requested assisted suicide. We aimed to identify both manifest and latent motifs in the patients' accounts, referring to the attachment theory and a psychodynamic analysis based on the concepts of the Ideal ego, the Ego ideal and the Superego. Different categories of motifs for assisted suicide requests were expressed by the patients. We also found indications of insecure and secure attachment, and underlying feelings of shame and abandonment, more rarely of guilt. In addition to limitations related to the patient's condition, the gatekeeper position limits the possibilities of addressing these issues or using them therapeutically with the patient. The psychiatrist' role as a gatekeeper in assisted suicide is uncomfortable. He or she must think about how to assume this role while remaining being a liaison psychiatrist.

IntroductionPhysician interpersonal competence is crucial for patient care. How interpersonal competence develops during undergraduate medical education is thus a key issue. Literature on the topic consists predominantly of studies on empathy showing a trend of decline over the course of medical school. However, most existing studies have focused on narrow measures of empathy. The first aim of this project is to study medical students’ interpersonal competence with a comprehensive framework of empathy that includes self-reported cognitive and affective empathy, performance-based assessments of emotion recognition accuracy, and a behavioural dimension of empathy. The second aim of the present project is to investigate the evolution of mental health during medical school and its putative link to the studied components of interpersonal competence. Indeed, studies documented a high prevalence of mental health issues among medical students that could potentially impact their interpersonal competence. Finally, this project will enable to test the impact of mental health and interpersonal competence on clinical skills as evaluated by experts and simulated patients.Methods and analysisThis project consists of an observational longitudinal study with an open cohort design. Each year during the four consecutive years of the project, every medical student (curriculum years 1–6) of the University of Lausanne in Switzerland will be asked to complete an online questionnaire including several interpersonal competence and mental health measures. Clinical skills assessments from examinations and training courses with simulated patients will also be included. Linear mixed models will be used to explore the longitudinal evolutions of the studied components of interpersonal competence and mental health as well as their reciprocal relationship and their link to clinical skills.Ethics and disseminationThe project has received ethical approval from the competent authorities. Findings will be disseminated through internal, regional, national and international conferences, news and peer-reviewed journals.

This commentary came from within the framework of integrating the humanities in medicine and from accompanying research on disease-related issues by teams involving clinicians and researchers in medical humanities. The purpose is to reflect on the challenges faced by researchers when conducting emotionally laden research and on how they impact observations and subsequent research findings. This commentary is furthermore a call to action since it promotes the institutionalization of a supportive context for medical humanities researchers who have not been trained to cope with sensitive medical topics in research. To that end, concrete recommendations regarding training and supervision were formulated.

Physicians’ narratives are means to approach and comprehend their experiences. They reveal the practice of medicine, and inform about the physicians’ embedment in their work and the healthcare context. This study aimed to examine physicians’ experience by means of interviews based on “narrative facilitators”, which goal is to encourage storytelling and to support the narrative process. Core stories were elaborated on the key aspects that emerged from the analysis. Thirty-three physicians participated in the study. The findings showed a focus on the transformations of a profession, the need for physicians to adapt in terms of role and status, and their withstanding of conflicting projections from the public and patients. The institutional context was described as darkness in which physicians are moving. When reacting to the quotes from their peers, participants showed a variety of un-patterned stances with regard to different aspects of medicine and the medical profession. Findings also indicated that as narrators, physicians may have particular difficulties accessing their inner world. Disenchanted physicians are not beneficial, neither for the patient nor for the health care system, and their feeling of being worn out may do harm and is certainly negatively affecting themselves and their families.

Men die more by suicide than women, but women attempt suicide more frequently. Gender does indeed shape suicidal ideas and behaviors. Due to differences in the way men express their suffering, men's depression may be underdiagnosed and undertreated. Furthermore, regarding suicidal behaviors, men use more lethal suicide methods than women. Their suicidal process seems also to progress more rapidly, which is probably related to their frequent substance use. Clinicians and researchers should consider these differences in their approach, without reducing men and women to their gender.Le paradoxe du genre dans le suicide renvoie au fait que les hommes se suicident plus que les femmes, alors que ces dernières font plus de tentatives de suicide. Ce phénomène s’expliquerait par l’influence du genre dans ce qui détermine les idées et les conduites suicidaires. Des manifestations différentes de la souffrance psychologique pourraient d’abord conduire à un défaut de reconnaissance des dépressions masculines. Ensuite, au niveau même des comportements suicidaires, les hommes optent pour des moyens plus létaux et l’évolution de leur processus suicidaire est plus rapide, entre autres en lien avec le fait qu’ils consomment plus fréquemment des substances. Les cliniciens et les chercheurs devraient prendre ces différences en considération dans leur approche, sans réduire hommes et femmes à leur appartenance de genre.

Objective This paper reports on the continuation of an initial study that demonstrated the effectiveness, as rated by experts, of an undergraduate training in breaking bad news (BBN) using simulated patient (SP) and individual feedback. The current study aimed to further explore whether such an individualized training approach also has positive effects from the perspective of the patient, using the analogue patient (AP) methodology. Methods A subsample of 180 videotaped interviews with SPs were selected from the existing data set (N = 332), consisting of 60 pre- and post-training interviews of students benefiting from the individualized approach (intervention group) and 60 post-training interviews of students having small-group SP training and collective supervision (comparison group). Sixty-eight APs-healthy untrained observers-were asked to view the videotaped interviews while "putting themselves in the patient's shoes" and evaluate satisfaction, trust, liking, and the competence of medical students. Results The intervention group students improved significantly from pre- to post-training on several dimensions evaluated by the APs: patient satisfaction, trust in the student, liking of the student, and perceived medical competence. Increased AP satisfaction was related to different changes in students' communication behavior between pre- and post-training: increase in positive talk, emotional responsiveness, biomedical and psychosocial information, and biomedical counseling. There was no significant between-group difference at post-training. Conclusions AP evaluation showed significant improvement between pre- and post-training. This result provides additional and complementary evidence of the positive effects of individualized training in BBN from the AP perspective, a proxy of (real) patients.

ObjectiveCollusion is a largely unconscious, dynamic bond, which may occur between patients and clinicians, between patients and family members, or between different health professionals. It is widely prevalent in the palliative care setting and provokes intense emotions, unreflective behavior, and negative impact on care. However, research on collusion is limited due to a lack of conceptual clarity and robust instruments to investigate this complex phenomenon. We have therefore developed the Collusion Classification Grid (CCG), which we aimed to evaluate with regard to its potential utility to analyze instances of collusion, be it for the purpose of supervision in the clinical setting or research.MethodSituations of difficult interactions with patients with advanced disease (N = 10), presented by clinicians in supervision with a liaison psychiatrist were retrospectively analyzed by means of the CCG.Result1) All items constituting the grid were mobilized at least once; 2) one new item had to be added; and 3) the CCG identified different types of collusion.Significance of resultsThis case series of collusions assessed with the CCG is a first step before the investigation of larger samples with the CCG. Such studies could search and identify setting-dependent and recurrent types of collusions, and patterns emerging between the items of the CCG. A better grasp of collusion could ultimately lead to a better understanding of the impact of collusion on the patient encounter and clinical decision-making.

Patients and their clinical predicaments have an impact on clinicians (that psychoanalysis frames as countertransference), but also on medical institutions. Suicidal patients provide a potent illustration of such phenomena. At the individual level, they evoke intense, often negative affective reactions. At the institutional level, they are also « difficult » patients, who often do not conform to the classical, « expected » sick role. This can result in policies too focused on risk assessment and strict procedures, potentially detrimental to proper care. To prevent such defensive attitudes, institutions should provide clinicians an environment in which they are able to work through their relationships with patients, but also with the medical profession and institutions.Parallèlement à ce qu’ils éveillent chez les cliniciens – les psychanalystes parlent de contre-transfert –, les patients ont des effets sur l’institution. La suicidalité en fournit un bon exemple. Au niveau individuel, la rencontre avec les patients suicidaires suscite des affects intenses et souvent négatifs. Au niveau institutionnel, ces patients, difficiles, rappellent les suicides passés et leurs effets traumatiques; ils peuvent être ambivalents vis-à-vis des soins et ne se conforment pas au rôle « attendu » des malades. En réaction, on peut observer des mouvements délétères, comme le développement de procédures trop focalisées sur l’évaluation du risque. Pour les prévenir, l’institution doit offrir aux cliniciens qui la font et la soignent un cadre pour penser leur relation aux patients, au métier et à l’institution elle-même.

The context of the clinical encounter, and more generally of the practice of medicine, has effects on physicians. For example, it shapes their opinions, discourses, and ultimately their behaviors. The context may also directly impact physicians, sometimes affecting their physical and mental health. Numerous interventions, provided within and outside the institution, are targeting these effects. The question we raise in this article is: should physicians adapt to, or should they rather situate themselves within, their context. This question leads us to discuss reflexivity and reflexivity training.Le contexte du médecin, « ce qui entoure » la rencontre clinique et, plus globalement, sa pratique, produit des effets sur lui, par exemple en orientant, déterminant et modelant ses opinions, ses discours et sa conduite. Ces effets peuvent se révéler délétères et atteindre les médecins dans leur santé physique et psychique. De nombreuses interventions et formations sont aujourd’hui ciblées sur ces effets et proposées dans et hors institution. La question que nous posons dans cet article est de savoir si les médecins doivent apprendre à s’adapter à leur contexte ou, plutôt, à s’y situer. Cela nous amène à traiter du processus de réflexivité et des formations à la réflexivité.

Resume En Suisse, comme ailleurs dans le monde, de nombreuses hotlines pour le soutien psychologique a la population ont vu le jour durant la phase aigue de la pandemie de COVID-19. Les professionnels en charge, generalement des specialistes de l’aide psychologique d’urgence, etaient aux prises avec une situation inedite, differente des catastrophes pour lesquelles ils se preparent habituellement. La pandemie et les mesures de distanciation menacant potentiellement la cohesion sociale, ils ont cherche, avec les hotlines, a reintroduire une forme de proximite, en soignant et cultivant le lien. La situation de pression et d’urgence, les inquietudes des autorites et de la population, ainsi que les attentes politiques et societales, ont favorise le developpement de ces structures. Des facteurs, comme le besoin d’etre utile et d’occuper une place ou celui d’agir pour maitriser les mouvements d’angoisse suscites par une situation inconnue et inquietante, ont certainement aussi joue un role chez les professionnels impliques. Dans l’ensemble cependant, ces hotlines n’ont ete que peu sollicitees, et leur utilite peut poser question. Cela renvoie a d’autres domaines ou ont pu naitre de nombreuses nouvelles offres, pas toujours en adequation avec les besoins identifies, alors meme que beaucoup de structures existantes etaient parallelement sous-employees, en particulier dans le domaine sanitaire. Ces constats plaident pour la necessite d’eviter les reponses dans l’urgence lors de situations de crise et de penser les dispositifs a mettre en place plutot que de les agir.

Background Many types of intervention exist for suicide attempters, but they tend not to sufficiently consider patient’s views. Aim To identify useful components of a previously evaluated intervention after a suicide attempt from the patient’s views and to better understand the process of recovery. Method Forty-one interviews with suicide attempters were qualitatively analysed. Views of participants (i) on the components of the intervention (nurse case-management, joint crisis plan, meetings with relatives/network and follow-up calls) and (ii) their recovery were explored. The material was analysed by means of thematic analysis with a deductive-inductive approach. Results Participants valued the human and professional qualities of the nurse case-manager, and appreciated follow-up calls and meetings. However, their views diverged regarding for instance frequency of phone calls, or disclosing information or lack thereof. Interpersonal relationship, suicide attempters’ own resources and life changes emerged as core recovery factors. Discussion The study highlights the figure of an engaged clinician, with both professional and human commitment, aware that some suicide attempters put more emphasis on their own resources than on delivered health care. Conclusions Interventions should consider the clinician as the cornerstone of the tailored care valued by suicide attempters.

Objective The present study explores students’ perspective on the added value of a virtual patient (VP) simulation as part of a breaking bad news training in undergraduate medical education. Methods The VP simulation allows trying out and practicing different ways of disclosing a cancer diagnosis to a VP (avatar) and to react to emotionally-laden patient statements with the opportunity of self-observation through video recording. After testing the simulation, 23 students shared their experience in focus groups analyzed using thematic analysis. Results Self-observation is the most valued feature of the simulation, because it enables users to reflect on their behaviors and adjust them. The competences developed are otherwise technical (e.g., organization of information) and concern less interactional competences. Areas for improvement of the simulation are the interactivity, quality, and diversity of the VPs. Conclusion The findings show that VP simulations help develop technical communication competences and are best suited as add-ons to other forms of training, in which relational aspects can be targeted. Self-observation is especially valued because it allows for a critical view regarding one’s own communication behaviors in a stress-free environment. Practice implications The proposed simulation is beneficial as an add-on to lectures, supervision, and simulated patient interviews.

Medicine is changing, and so are the causes of dissatisfaction among physicians. In a broader context characterized by the dominance of an economic rationality, in which medicine is shaped by the phenomenon of acceleration typical of modernity, we argue, in this brief article, that clinical practice is based on an engagement involving a form of suspension of the flow of time. Engagement is thereby an essential dimension of medicine, and is proposed as a lasting foundation of clinical practice.La médecine change et avec elle, les raisons de l’insatisfaction des médecins. Dans un contexte où prévaut notamment une logique de type économique et où le métier de médecin est marqué par l’accélération caractéristique de la modernité, nous avançons dans ce bref article de réflexion que la clinique se fonde sur un engagement impliquant une forme de suspension du temps. L’engagement constitue ainsi une dimension essentielle du métier médical et potentiellement un socle durable de la clinique.

Background Since there is sound evidence that communication skills training (CST) programs modify communication behavior of oncology clinicians, they have been widely implemented over the last decades. However, more recently, certain aspects of this training have been criticized. Methods Based on this background, a call to re-launch a discussion about the future of CST led to the third European consensus meeting on communication in cancer care, organized by the Swiss Cancer League. During this meeting, which brought together European experts in the field of clinical communication and training of communication in the oncology setting, oncology clinicians, representatives of the European Society of Medical Oncology and a member of the European Oncology Nursing Society, the recommendations of the second European consensus meeting were updated and expanded. Results The expanded recommendations recall the guiding principles of communication in cancer care, underline the important role of clinician’s self-awareness, and of relational and contextual factors in clinical communication, and provide direction for the further development of communication training. Conclusion This third European consensus meeting defines key elements for the development of a next generation of communication training for oncology clinicians.