Classifying reactions to difficult

patients A reproducible didactic conference for medical students Robert F McFadden MD Alexandra H Sawicki PGY1 Emory University Abstract We describe a one hour interactive conference given during medical students psychiatry clerkship We introduce a framework for examining classifying and understanding reactions to difficult patients This exposes students destined for all medical specialties to a consistent method of examining patient interactions This conference brings psychodynamicallyoriented faculty into contact with the entire student body in the service of improving students ability to respond to diagnose and care for patients Some medical schools have held group discussions of problematic patient encounters without a structured didactic component Prior to our conference taught once per clerkship students are surveyed and asked to describe a troubling psychiatry patient encounter Information is gathered about what troubles students and how the students reacted This retrospective survey encourages growth of students observing ego regarding their feelings and reactions as a physician During the realtime conference we teach students to distinguish between three types of reactions justified reactions projective identification reactions and countertransference reactions We lead students through a problembased learning exercise to practice applying this concept Time is allowed for discussion of how this classification can guide students after a troubling patient encounter This conference addresses the important often ignored issue of students reactions to troubling patient encounters with a systematic and reproducible classification system that could be taught in an hourlong lecture at medical schools throughout the country This will give students a lifelong protective layer of insight that will allow them to respond in healthier more empathetic ways to patients

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