Patient–Caregiver Relationship

Since its inception, the Montpellier-Nîmes Faculty of Medicine has been particularly committed to teaching humanistic medicine. It was one of the first faculties to offer workshops dedicated to the patient-caregiver relationship. In 2013, a unique collaboration agreement was signed between the Montpellier-Nîmes Faculty of Medicine and the Montpellier National School of Dramatic Arts. Students are co-supervised by healthcare professionals and drama teachers to prepare them for difficult case presentations. 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 premises specially dedicated to this type of teaching.

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2013

year the system was created

250

approximately students trained each year

2066

students trained since the program began

A humanistic approach to education that supports the patient-caregiver relationship

The Faculty of Medicine offers its fourth-year students a unique compulsory workshop as part of one of their oncology teaching modules. This four-hour workshop allows students to prepare for the difficult experience of breaking the news to patients and their loved ones, with actors playing the roles of patients and relatives, a director, and a professor of medicine.

To ensure a comprehensive and optimal experience, students participate in these workshops in small groups of up to 15 learners. They prepare for a difficult announcement based on four scenarios:

First cancer diagnosis
Announcement of recurrence of treated cancer
Telling parents about their child's cancer
Announcement of discontinuation of specific treatments and transition to palliative care

Workshop procedure according to the 2018 educational report

Workshop Schedule

This is an introductory workshop preparing participants for the patient-caregiver relationship: a transition from theory to initial practical experience. How can you clearly, concisely, and publicly describe a medical case, its issues, and its relational context?

The workshop consists of several phases: going to fetch the patient from the ward, introducing yourself, addressing them by name, inviting them to your office depending on the situation, or consulting with a patient who is bedridden in the hospital.

Medical students are not judged, analyzed, or evaluated as individuals, nor are they assessed on their knowledge or skills. The aim is to ensure that this experience is a practical and clinical introduction that opens them up to their profession and future responsibilities. They learn as much by participating in role-playing exercises as they do by observing those who are being assessed.

Workshop Objectives

The aim is to introduce students to the urgent and immediate demands of contemporary society. To highlight their qualities and skills, but also to point out weaknesses, identify clinical errors, and work on the quality of their presence, such as slowing down their speech or avoiding unfortunate words that slip out in their interactions with patients. The student workshop is inductive, constantly shifting between practice and theory while circumventing fears and prejudices.

The medical professor and the director give their opinions and advice based on their respective areas of expertise. The fifteen students are divided into three groups to role-play different scenarios involving the delivery of bad news. The trainers chose oncology because it is socially emblematic of all the tensions, fears, pain, and relationship difficulties involved.

Group 1: Initial diagnosis of cancer in a person (breast, uterus, prostate, lung, skin, liver, colon, etc.).
Group 2: Announcement of cancer recurrence and therefore dealing with the distress, denial, refusal, etc. of patients and their loved ones.
Group 3: Informing parents that their child has leukemia or cancer. Or: Informing a person, alone or accompanied, in a hospital bed or at the office, that curative treatment will be 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 in an upright posture (without hands in pockets, without crossed or fidgeting legs, without hesitation or stumbling) announce:

His first and last name,
The medical case,
The gender of the sick person, their age,
The patient's social situation, intimate situation, living alone, etc.
He must then go to the waiting room, introduce himself, and greet the patient, with or without a handshake.

What are students and instructors working on?

The attending professor comments on the medical content and explains if there are any errors or ambiguities.

The director works on the quality of the handshake at the beginning, body position, delivery of the text, distances, rhythm, and each person's specific performance. Simple but basic things: explaining with a drawing or on screen what the patient can no longer hear or understand; or how to change places to be at the bedside of the dying patient.

Review

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

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

What remains fundamental in this introduction for medical students is not the medical knowledge displayed (although any errors or missteps are pointed out by the medical professor present) but the way in which each future doctor will encounter and treat each case presented.

At the end of this session, the students told us that in four hours of interaction, listening, observation, and action "in the field," they understood something that no theoretical course could offer them: the humanization of the doctor-patient relationship, its living ethics, in the face of what patients and their companions, friends or family are going through.

These workshops involved all 250^fourth -year students, with attendance mandatory.