title: The stories they tell: How third year medical students portray patients, family members, physicians, and themselves in difficult encounters.
abstract: BACKGROUND
  Physicians have long had patients whom they have labeled "difficult", but little is known about how medical students perceive difficult encounters with patients.
  
  
  METHODS
  In this study, we analyzed 134 third year medical students' reflective essays written over an 18-month period about difficult student-patient encounters. We used a qualitative computerized software program, Atlas.ti to analyze students' observations and reflections.
  
  
  RESULTS
  Main findings include that students described patients who were angry and upset; noncompliant with treatment plans; discussed "nonmedical" problems; fearful, worried, withdrawn, or "disinterested" in their health. Students often described themselves as anxious, uncertain, confused, and frustrated. Nevertheless, they saw themselves behaving in empathic and patient-centered ways while also taking refuge in "standard" behaviors not necessarily appropriate to the circumstances. Students rarely mentioned receiving guidance from attendings regarding how to manage these challenging interactions.
  
  
  CONCLUSIONS
  These third-year medical students recognized the importance of behaving empathically in difficult situations and often did so. However, they often felt overwhelmed and frustrated, resorting to more reductive behaviors that did not match the needs of the patient. Students need more guidance from attending physicians in order to approach difficult interactions with specific problem-solving skills while maintaining an empathic, patient-centered context.
authors.affiliation: a Department of Family Medicine , University of California Irvine School of Medicine , Orange , CA , USA.
authors.forename: Johanna
authors.initials: J
authors.lastname: Shapiro
authors.affiliation: b College of Osteopathic Medicine, Kansas City University of Medicine and Biosciences, College of Osteopathic Medicine , Kansas City , MO , USA.
authors.forename: Pavandeep
authors.initials: P
authors.lastname: Rakhra
authors.affiliation: c California State University , Fullerton , CA , USA.
authors.forename: Adrianne
authors.initials: A
authors.lastname: Wong
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002140:California; D004504:Education, Medical, Undergraduate; D004644:Emotions; D004645:Empathy; D005190:Family; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010361:Patients / Q000523:psychology; D010817:Physician-Patient Relations; D010820:Physicians; D011368:Professional-Family Relations; D012577:Schools, Medical; D012649:Self Concept; D013337:Students, Medical / Q000523:psychology*; D014956:Writing; D055815:Young Adult