Patient-Caregiver Relationship

From the outset, the Montpellier-Nîmes Faculty of Medicine has been particularly committed to teaching a humanistic approach to medicine. It was one of the pioneering faculties to set up workshops dedicated to the patient-caregiver relationship. Since 2013, a unique collaboration protocol has been signed between the Montpellier-Nîmes Faculty of Medicine and the École Nationale Supérieure d'Art Dramatique de Montpellier. Students are co-supervised by healthcare and drama professionals to prepare for difficult case announcements. 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 teaching.

2013

year the system was created

250

students trained each year

2066

students trained since the scheme began

A humanist approach to patient-caregiver relations

The Faculty of Medicine is offering its 4th year students a unique compulsory workshop as part of one of their cancer teaching modules. This 4-hour workshop enables students to prepare for the difficult first announcement experience, in front of actors playing patients and their relatives, a director and a professor of medicine.

To guarantee a complete and optimal experience, students take part in these workshops in small groups of no more than 15 learners. They prepare for a difficult announcement according to 4 scenarios:

First diagnosis of cancer
Announcement of recurrence of treated cancer
Notifying parents of childhood cancer
Announcement of cessation of specific treatments and transition to palliative care

Workshop schedule according to the 2018 pedagogical report

Workshop procedure

This is an introductory workshop for the patient-caregiver relationship : a transition from theory to a first practical experience: how to clearly, briefly and publicly state a medical case, its problems and its relational context?

The workshop includes several phases: picking up the patient from the ward, introducing oneself, naming the patient, inviting the patient to the office according to different announcement situations, or consulting the bedridden patient in hospital.

Medical students are neither judged, nor analyzed, nor evaluated as individuals, nor on their knowledge or skills. The aim is for this experience to be a practical and clinical initiation that opens them up to their profession and future responsibilities. They learn as much from performing as they do from observing others perform.

Workshop objectives

The aim is to introduce students to the conditions of urgency and immediacy in contemporary society. It's about highlighting their qualities and aptitudes, but also pointing out areas of weakness, noting clinical errors, acting on the quality of their presence, such as slowing down the speed of their speech or avoiding unfortunate words that escape them in their dealings with patients. The workshop for students is inductive, in a constant dialectic of moving from the practical to the theoretical, bypassing fears and prejudices.

The attending professor of medicine and the director give their opinions and advice on the field, based on their respective expertise. The fifteen students will be divided into three groups, to embody the experiences of announcement. The trainers chose cancerology because it is socially emblematic of all the tensions, fears, pain and relational difficulties.

Group 1 : A person's first cancer diagnosis (breast, uterus, prostate, lung, skin, liver, colon, etc.).
Group 2 : Announcement of a cancer recurrence, and confrontation with the confusion, refusal, denial, etc. of patients and their families.
Group 3 : Announcement to parents of their child's leukemia or cancerous tumor. Or: Announcement to a person, alone or accompanied, on a hospital bed or in the office, of the cessation of treatment aimed at recovery, in order to move on to palliative care.

A common ritual for all three teams

The director decides the case but not the person. The medical student must announce clearly and in an upright body posture (no hands in pockets, no crossed or restless legs, no hesitation or fumbling):

First and last name,
The medical case,
The patient's gender and age,
The patient's social and intimate situation, whether alone or accompanied, etc.
He must then go into the waiting room, introduce himself and greet the patient, with or without an attendant, with a handshake.

What are students and trainers working on?

The medical professor in attendance comments on the medical content and explains any errors or confusion.

The director works on the quality of the initial handshake, body position, text delivery, distances, rhythm and the specific performance of each individual. Simple but basic things: explaining with a drawing or on a screen what the patient no longer hears or doesn't understand; or how to change places to be at the bedside of the dying patient.

Balance sheet

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

What have I learned about myself in the process?
What have I learned from observing other students?

What remains fundamental in this introduction to medical students is not the medical knowledge deployed (although any errors or oversights will be pointed out by the professor of medicine present) but the way in which each future doctor will encounter and deal with each announcement case.

At the end of this session, the students confide in us that in four hours of intervention, listening, observation and action "in the field", they understand what no theoretical course can offer them: the humanization of the doctor-patient relationship, its living ethicsin the face of what patients and their carers, friends and family, are going through.

These workshops were attended by all 250^4th-year students, with compulsory attendance.