‘Demystifying’ the encounter with adolescent patients: a qualitative study on medical students’ experiences and perspectives during training with adolescent simulated patients

Figures & data

Figure 1. Illustration of data collection and recruitment procedures – TS = training session, ASP = adolescent simulated patients. We conducted in-field observation during training sessions 1 to 6 and recruited 18 students for interviews in training sessions 1 to 4 and 6.

Table 1. Summary of main categories, themes and subthemes that emerged from the first phase of the data analysis (initial, focused and axial coding)

Categories	Themes	Subthemes
Anticipating the challenge	Displaying preconceptions about adolescents	Perceived specificities and needs related to the adolescence period Communication & interaction challenges with adolescent patients
	Observing the relational closeness with adolescents	‘Emotional’ closeness with adolescents ‘Social’ closeness with adolescents
	Facing the unknown	Past professional and personal experiences with adolescents Anticipated difficulties with specific skills and knowledge in adolescent health
‘Demystifying’ the challenge through experience	Modulating preconceptions through experience	Modulating preconceptions
	Adjusting the professional distance	Dealing with one’s own experience of adolescence Adjusting the relational distance
	Uncovering the unknown	Having ‘done it once’ Observing and practicing concrete interviewing skills
Coping with the educational setting	Coping with the small group setting	Fragmentation of the interview Presence of observers Active observation and group discussion
	Coping with the simulated setting	Purpose and benefits of simulation Authenticity and professionalism of ASP

Figure 2. Illustration of the process of anticipating and ‘demystifying’ the challenge through the experience with an adolescent simulated patient

Table

Themes and definitions	Additional significant quotes or field notes
1. PRECONCEPTIONS ABOUT ADOLESCENTS
Displaying preconceptions about adolescents
Refers to examples of students’ preconceived ideas about adolescence as a unique period of life with specific needs and about certain specific behaviors of adolescents that influence the way they communicate or interact with professionals	‘In my head, adolescence is a time when anything can happen, and we have the feeling that we need to handle [adolescents] with kid gloves’ (Dimitri, session 2). ‘Maybe we fear adolescents a bit because we know that it is more difficult to communicate with them, they may be less open about their private life’ (Rachel, session 3).
Modulating preconceptions through experience
Refers to how the training session helped change the students’ perspective on their preconceptions	‘The training session allowed me to see that even if adolescents didn’t necessarily want to be there for the interview […], it didn’t prevent them from talking or from establishing a trustful relationship.’ (Sylviane, session 1)
2. LEVEL OF EXPERIENCE WITH ADOLESCENT PATIENTS
Facing the unknown
Refers to how students perceive the challenge related to their lack of experience with adolescents, and the subsequent lack of skills and knowledge in specific areas of adolescent health and medicine	‘Because here we’re kind of thrown into the deep end, like: “ok let’s go, take the history of an adolescent”. So for us, it’s like, well, do we have to do the HEAADSSS (psychosocial history)? Do we have to do it like with adults? Do have to focus on the complaint or not? well, there you go. It’s just that I don’t really know what to expect at the moment’ (Lamia, session 3) Excerpt from field notes (session 2): ‘One student interrupts the role play as soon as the somatic history is over, which she has done well. She talks about her discomfort at not knowing how to continue in the HEADS psychosocial interview which is more specific to adolescent health’.
Uncovering the unknown
Refers to the perceived added value of having the experience itself but also to how the training helped students observe or practice some interviewing techniques themselves.	‘It defused something in relation to adolescents. As I said before, it was the first time that I talked to an adolescent being myself out of adolescence. And it put me more at ease.’ (Dimitri, session 2) ‘I think it’s important to keep this idea that the HEAADSSS interview must be flexible, that it’s not fixed, that it can be modulated and that each adolescent will react differently. And to also have in mind this notion of how to set a framework, […] that it often helps the good progress of the interview … if we explain again and again that it is confidential’ (Marie, session 2)
3. PROFESSIONAL DISTANCE
Observing the relational closeness with adolescents
Refers to how students feel close to and even identify with adolescents either on an emotional level, for example by projecting themselves into their own adolescent experience, or on a social level in terms of age proximity and sharing common interests or activities	‘So, at one point, it was up to one of my friends to interview him (the adolescent) and I know that my friend likes to smoke joints and so with all my friends, we were laughing about the situation. You know to watch him playing the doctor and giving advice to someone who has problems with cannabis’ (Dimitri, session 2)
Adjusting the professional distance
Refers to how students manage distance from their own adolescent experience in the assessment and management of adolescent patients and to how students deal with the small age difference and social proximity in the professional doctor-patient relationship	‘I used to play at video games, and so did all of my friends. And finally, we ended up at the university, so it doesn’t have a huge impact. It’s cool to play at video games.’ (Lauriane, session 4). Excerpt from field notes (session 5): ‘The simulated patient provides feedback to the student about some smiles during the consultation and her somewhat “cool” attitude that bothered her a bit and that she felt was out of step with the case. The student said she wanted to joke around a bit to lighten the atmosphere. The teacher takes this opportunity to provide some insights about the age difference issue and the need to not act like the adolescent’s buddy by citing a study on this topic. A student then asks for confirmation that one should not adopt such a “cool” attitude.’