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11 Filling the void: preparing future junior doctors for challenging conversations
  1. Hannah Costelloe,
  2. Alice Copley,
  3. Andrew Greenhalgh,
  4. Andrew Foster and
  5. Pratik Solanki
  1. Princess Alexandra Hospital, Harlow, Essex, UK


Evidence demonstrates that medical students have limited experience in developing ‘higher-order communication skills’ (Kaufman et al. 2000). Anecdotally many do not feel confident in their ability to conduct difficult conversations often due to a lack of exposure to such scenarios in practice or a pervasive notion that these scenarios are inappropriate for students and beyond the scope of a junior doctor’s role and thus not a focus of curriculums (Noble et al. 2007). There is however a correlation between level of clinical experience and improved confidence for medical students (Morgan and Cleave-Hogg 2002).

We surveyed a group of final year medical students to assess their confidence using a 10-point Likert scale in tackling common palliative and end of life care scenarios. Our intervention comprised a study day of 10 practical small-group teaching simulation and OSCE-style stations designed to provide exposure to common experiences in a controlled setting. We reassessed the confidence of students after delivery and objectively explored the impact of the day by asking participants to complete a validated assessment before and after the course. All results showed significant improvement on t-testing: confidence in end of life communication in an OSCE setting improved by 42.2% and assessment marks improved by 24.7% (p=0.039).

Palliative care is an area in which students approaching the end of undergraduate training feel underprepared. Our findings demonstrate that small group sessions improve confidence by facilitating communication practice in a controlled environment and providing crucial exposure to common palliative care scenarios they will face as doctors.


  1. . Kaufman D, Laidlaw T, Macleod H. Communication skills in medical school: Exposure confidence and performance. Academic Medicine [online] 2000;75(10):S90–S92. Available at [Accessed: 30 May 2018]

  2. . Morgan P, Cleave-Hogg D. Comparison between medical students’ experience confidence and competence. Medical Education [online] 2002;36(6):534–539. Available at [Accessed: 30 May 2018]

  3. . Noble L, Kubacki A, Martin J, Lloyd M. The effect of professional skills training on patient-centredness and confidence in communicating with patients. Medical Education [online] 2007;41(5):432–440. Available at [Accessed: 30 May 2018]

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