Patient–Caregiver Relationship

The Montpellier-Nîmes Faculty of Medicine has, from its very inception, placed particular emphasis on teaching a humanistic approach to medicine. As such, it was among the first faculties to establish workshops dedicated to the patient-caregiver relationship. Since 2013, a one-of-a-kind collaboration agreement has been in place between the Montpellier–Nîmes School of Medicine and the National School of Dramatic Arts in Montpellier. Students are thus co-supervised by professionals from the fields of healthcare and the dramatic arts to prepare them for difficult case presentations. To date, this collaboration makes the program unique in France. Since the opening of the Arnaud de Villeneuve Campus in 2017, the Faculty has provided its students with facilities specifically dedicated to this type of instruction.

2013

year the program was established

250

approximately [number] students trained each year

2066

students trained since the program began

A Humanistic Approach to Education in Support of the Patient-Caregiver Relationship

The School of Medicine offers its fourth-year students a one-time mandatory workshop as part of one of their oncology courses. This four-hour workshop allows students to prepare for the challenging experience of delivering the initial diagnosis, in the presence of actors playing patients and their loved ones, a director, and a medical professor. 

To ensure a comprehensive and optimal experience, students participate in these workshops in small groups of no more than 15 students. They prepare to deliver a difficult announcement based on four scenarios:

  • First Cancer Diagnosis
  • Notice of Recurrence of a Previously Treated Cancer
  • Telling Parents About Their Child's Cancer
  • Notice of Discontinuation of Specific Treatments and Transition to Palliative Care

How a Workshop Is Conducted According to the 2018 Educational Report

Workshop Schedule

This is an introductory workshop designed to prepare participants for the patient-caregiver relationship: a transition from theory to a first practical experience. How can one clearly, concisely, and publicly present a medical case, its challenges, and its relational context?

The workshop consists of several phases: picking up the patient from the waiting room, introducing oneself, addressing the patient by name, inviting the patient to the office using various opening lines, or consulting with a bedridden patient in the hospital.

Medical students are not judged, analyzed, or evaluated as individuals, nor are they evaluated based on their knowledge or skills. The goal is to ensure that this experience serves as a practical and clinical introduction that prepares them for their profession and future responsibilities. They learn just as much by participating in role-playing exercises as they do by observing others who are participating.

Workshop Objectives

The goal is to introduce students to the urgent and immediate demands of contemporary society. To highlight their strengths and skills, but also to point out areas of weakness, identify clinical errors, and work on the quality of their presence—such as slowing down their speech or avoiding inappropriate words that slip out when interacting with patients. The student workshop takes an inductive approach, engaging in a constant back-and-forth between practice and theory while overcoming fears and prejudices.

The medical professor and the theater director offer their opinions and advice on the spot, drawing on their respective areas of expertise. The fifteen students will be divided into three groups to act out scenarios involving the delivery of medical news. The instructors chose oncology because it is socially emblematic of all the tensions, fears, pain, and relationship difficulties involved.

  • Group 1: A person’s first cancer diagnosis (breast, uterine, prostate, lung, skin, liver, colon, etc.).
  • Group 2: Announcement of a cancer recurrence and, consequently, dealing with the distress, refusal, denial, etc., experienced by patients and their loved ones.
  • Group 3: Informing parents that their child has leukemia or a cancerous tumor. Or: Informing a person—whether alone or accompanied—in a hospital bed or at an office—that curative treatments are being discontinued in favor of palliative care.

A ritual shared by all three teams

The director decides on the case but not on the person. The medical student must clearly—and while maintaining an upright posture (without hands in pockets, without crossing or fidgeting with the legs, and without hesitation or stumbling over words)—announce:

  1. His first and last name,
  2. The medical case,
  3. The gender of the patient, their age,
  4. The patient's social situation, personal circumstances, whether they are living alone, etc.
  5. He should then go to the waiting room, introduce himself, and greet the patient—whether or not they are accompanied—with a handshake.

What are the students and instructors working on?

The featured medical professor reviews the medical content and clarifies any errors or ambiguities.

The director works on the quality of the initial handshake, body posture, delivery of the lines, spacing, rhythm, and each actor’s specific performance. Simple but fundamental things: explaining with a drawing or on a screen what the patient can no longer hear or understand; or how to move to the bedside of a dying patient.

Summary

At the end of the workshop, each student answers the following two questions orally:

  • What did I learn about myself during my time there?
  • What did I learn from observing the other students?

What remains fundamental in this introductory course for medical students is not the medical knowledge presented (although any errors or missteps are pointed out by the medical professor in attendance) but the way in which each future doctor will approach and handle each case presented.

At the end of this session, the students tell us that in four hours of discussion, listening, observation, and “hands-on” experience, they have gained an understanding that no theoretical course can offer them: the humanization of the doctor-patient relationship and its living ethics, in the face of what patients and their caregivers—friends or family—are going through.

These workshops were open to all 250fourth-year students, and attendance was mandatory.