title: Finding the Words: Medical Students' Reflections on Communication Challenges in Clinic.
abstract: Interpersonal communication is essential to providing excellent patient care and requires ongoing development. Although aspects of medical student interpersonal communication may degrade throughout career progression, it is unknown what specific elements pose challenges. We aimed to characterize clerkship students' perspectives on communication challenges in the outpatient setting to help inform curricular development.
  
  
  
  Third-year medical students in a required family medicine clerkship were asked to describe a communication challenge they encountered. Open-ended written responses were collected through a mandatory post-clerkship survey. Responses were qualitatively coded using an a priori framework for teaching and assessing communication skills (The SEGUE Framework for Teaching and Assessing Communication Skills) with data-derived additions to the framework, followed by a team-based thematic analysis.
  
  
  
  We collected 799 reflections written by 518 students from 2007-2014. Three dominant themes emerged from the analysis: challenges with (1) effectively exchanging information with patients, (2) managing emotional aspects of the patient encounter, and (3) negotiating terms of the encounter.
  
  
  
  Communication curricula focus on content and process of the medical interview, but insufficient time and energy are devoted to psychosocial factors, including aspects of the encounter that are emotionally charged or conflicting. While gaps in students' communication skillsets may be anticipated or observed by educators, this study offers an analysis of students' own perceptions of the challenges they face.
authors.affiliation: Stanford University School of Medicine.
authors.forename: Genna
authors.initials: G
authors.lastname: Braverman
authors.forename: Sylvia
authors.initials: S
authors.lastname: Bereknyei Merrell
authors.forename: Janine S
authors.initials: JS
authors.lastname: Bruce
authors.forename: Gregory
authors.initials: G
authors.lastname: Makoul
authors.forename: Erika
authors.initials: E
authors.lastname: Schillinger
mesh_terms: D000554:Ambulatory Care Facilities; D002982:Clinical Clerkship; D002983:Clinical Competence; D003142:Communication; D004504:Education, Medical, Undergraduate; D004645:Empathy; D005194:Family Practice / Q000193:education; D006801:Humans; D010817:Physician-Patient Relations; D013337:Students, Medical / Q000523:psychology*; D011795:Surveys and Questionnaires; D014956:Writing