Trying to make a difference: One medical student at a time

Clique aqui para ler a versão em português

Bárbara Antunes, Research Associate at Centro de Estudos e Investigação em Saúde da Universidade de Coimbra (CEISUC), Portugal, and Visiting Research Associate at Cicely Saunders Institute, King’s College London, UK.

Bárbara Antunes

Bárbara Antunes

Being a full-time researcher at King’s College London allowed me to acquire new skills, but it also meant I would be away from clinical psychology practice for a number of years.

In order to stay in the ‘real world’ I explored options. One of the best things I did was to facilitate role-playing communication sessions with medical students at King’s College London. From first years, on managing the clinical interview, to final years –almost doctors – on how to break bad news. These were the most challenging, but the most rewarding sessions.

All groups are different, and of the 10 to 15 students per group, two or three will get to role-play in each 30-minute session. My favourite bit is at the end of the role-playing, after everyone has had a chance to share their thoughts and feelings: when they realise that in that particular moment, with that particular person, the best possible medical care they can deliver is not CPR manoeuvres or a highly complex drug prescription… rather it is to bear witness to that life-altering moment. To be silent. To acknowledge the person’s reality has changed forever, because before that conversation they still had a mother, or were healthy or were not faced with extremely difficult choices. It is to listen, to support someone’s anguish and sadness and to let them know they are not alone. To offer a tissue, a glass of water, or ask if there is someone they would like you to ring.

“And we just stand there?’’
You’re not ‘just’ standing there, you are ‘with’ them. You’re not answering the phone or checking messages, nothing is more important than that moment. Because you cannot change circumstances or save someone from death when it’s their time. But you can make people feel cared for. When they go home they might not remember half of what was said, but they will never forget your attitude, possibly in years to come. ‘’That was the worse day of my life, but the doctor was really nice to me, just stayed there to make sure I was okay and offered help,’’ as opposed to ‘’Not only it was the worse day of my life but the doctor seemed like they had more important things to do, they just brushed me off. It’s not right!’’

After the person leaves, it’s your turn to vent, if you need to – either with colleagues, alone, or with family and friends. And that is when, hopefully, I see the ‘epiphany’ look. Then I know they ‘got it’ and can only hope that they will remember when practising medicine: it’s about caring for another human being.

If you’d like to share your experiences of being part of an international research project please leave a comment below, or contact via email or Twitter: @B_CP_Antunes

Find out more…
If you’ve enjoyed this post, you might also be interested to read Dr Birgit Jaspers’ post on the EAPC blog describing a seminar for medical students where hospice volunteers act as patients.


Tentando fazer a diferença: um aluno de medicina de cada vez

Bárbara Antunes, Investigadora Colaboradora do Centro de Estudos e Investigação em Saúde da Universidade de Coimbra (CEISUC) Portugal e Investigadora Convidada no King’s College London, Instituto Cicely Saunders, Reino Unido.

Bárbara Antunes

Bárbara Antunes

Ser investigadora a tempo inteiro no King’s College London permitiu-me adquirir novas competências, ainda que tenha implicado ficar longe da prática clínica e, portanto, não exercer psicologia clínica durante alguns anos. Para ficar em contacto com o “mundo real” explorei opções. Uma das melhores coisas que fiz, foi facilitar sessões de role-playing em comunicação para os alunos de medicina da universidade. Desde alunos primeiro ano, sobre como realizar a entrevista clínica, até aos alunos do último ano – quase médicos – como dar más notícias. As sessões mais difíceis, mas as mais recompensadoras.

Todos os grupos são diferentes, e dos 10 a 15 estudantes por grupo, dois ou três terão a oportunidade de fazer role-playing durante cada sessão de 30 minutos. A minha parte favorita é no final do role-playing, depois de todos terem tido a oportunidade de partilhar os seus pensamentos e sentimentos: quando compreendem que, quando estiverem no mundo real, num determinado momento e com uma pessoa em particular, o melhor tratamento médico possível não será uma manobra de reanimação cardiorespiratória, ou prescrição complexa de medicamentos… antes, será testemunhar um momento preciso que para sempre alterará vidas. Estar em silêncio. Validar que a realidade daquela pessoa mudou para sempre, porque antes daquela conversa, a pessoa ainda tinha Mãe, ou era saudável, ou não estava perante decisões médicas complicadíssimas. Ouvir, suportar a angústia e tristeza daquela pessoa e permitir-lhe saber que não está sozinha. Oferecer um lenço, um copo de água ou perguntar se há alguém a quem gostaria que se telefonasse.

“E ficamos ali apenas?”
Não ficam “só” ali, estão com “com” aquela pessoa. Não estão ao telefone ou a ver mensagens, nada é mais importante do que aquele momento. Porque ninguém pode mudar as circunstâncias ou salvar alguém da morte quando chega a sua hora. Mas podem fazer com que sinta que alguém se preocupa. Quando aquela pessoa for para casa poderá não se lembrar de metade do que foi dito, mas nunca esquecerá a vossa atitude, possivelmente durante anos: “foi o pior dia da minha vida, mas o/a médico/a foi muito simpático/a, ficou comigo para se certificar de que eu estava bem e ofereceu-me ajuda.” Ao invés de “não só, foi o pior dia da minha vida, mas o/a médico/a parecia que tinha coisas mais importantes para fazer, simplesmente despachou-me! Não está certo!”. Depois da pessoa sair é a vossa vez de ventilar, se sentirem que é necessário. Seja com colegas, sozinho/a ou com família e amigos.

E é nesse momento, espero eu, que vejo os olhares de ‘epifania’. Aí sei que compreenderam e só posso desejar que se lembrem quando exercerem medicina: é sobretudo cuidar de outro ser humano.

Se quiser partilhar as suas experiências de fazer parte de um projeto internacional, por favor deixe o seu comentário abaixo, ou contacte via email ou Twitter: @B_CP_Antunes

Obrigada à Dra Sofia Vilar Soares pela revisão do texto em Português.

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3 Responses to Trying to make a difference: One medical student at a time

  1. Pingback: Trying to make a difference: One medical student at a time | EAPC Blog | All Things Palliative - Article Feed

  2. Namakau Nalumango says:

    Dear Bárbara Antunes

    This kind of work reminds me of what I do with medical students at the University of Otago. I am a volunteer who takes on various ailment roles to give students first experiences with meeting patients and diagnosing their conditions. We report on how the ‘young doctors’ handle us as people. Reading about your work in End-of-Life care experience touched a very soft spot in me. 

    I just completed my research into the needs of End-of-Life family-carers in Sub-Saharan Africa. You need to know that they need this sort of care too- but it is not available. I will present the findings of my self-sponsored study at a conference in November, here in Dunedin, this year. At the end of my paper, I explain:

    I am not a medical person. I developed interest in palliative care just because of a unique exposure to the care of the terminally-ill in two totally different settings. I nursed my mother in an African village, attending to her 27-hour long moment-of-dying. It was my first time to witness dying even though I was 53 years old and the older of two sisters. I had never heard that dying could be violent or frightening. I carried the trauma with me to New Zealand, where I found myself caregiving in a modern respite care facility for the aged. My greatest fear when I landed that job was that I would see all those people writhing and croaking, if I happened to be on duty when they died. However, I witnessed a totally different form of dying. As death happened, my mind wanted answers: why did Mama die like that? 

    I have learned a lot during that cathartic research- most importantly, that my sister and I were not alone in lacking such support! I hope to publish my work when I have shared my findings with the academia, practitioners and whoever cares to listen at the conference.

    I will ask the medical student programme coordinator to consider role-playing for End-of-Life care experience initiation for our student doctors too.

    Kind regards,

    Namakau

    ________________________________

  3. Bárbara Antunes says:

    Dear Namakau Nalumango

    thank you for reading the post and for sharing your experiences. Indeed, caring for the dying is never easy and when they are loved ones it can be life altering.
    Your work as a volunteer is absolutely crucial for medical students for it helps them understand what it is that they will find when actually practicing medicine. I hope you can continue to do that very important work.
    I wish you the best of luck for your research – the Cicely Saunders Institute has substantial research conducted in Sub-Saharian Africa if it is of interest to you – and I sincerely hope that your suggestion for adding role-playing to the program is taken by the coordinator.

    Thank you again

    Best wishes
    Bárbara

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