Ann S. Botash,SUNY Upstate Medical University,Syracuse,NY,Amy E. Caruso Brown,SUNY Upstate Medical University,Syracuse,NY,Thomas R. Welch,SUNY Upstate Medical University,Syracuse,NY
Background: Vaccine hesitancy and refusal is an increasingly common and nearly inevitable challenge to professionalism in pediatric practice. Approaches to vaccine refusal, including addressing parental concerns, providing patient education, and offering risk-benefit analyses, require providers to employ excellent communication skills. Although much has been written about the perceptions of parents and physicians, the perspective of medical trainees and their interpretations of vaccine hesitancy encounters has not been previously reported. Student observations and reflections of these encounters may provide novel insights into pediatric practices as well as to the hidden curriculum.
Objective: To analyze student narrative themes identified in their written reflections regarding vaccine-hesitant families.
Methods: Two authors performed a qualitative analysis of reflective narratives submitted by third year pediatric clerkship medical students. The narrative assignment is open-ended and a required part of their professionalism grade. Narratives regarding vaccine hesitancy were identified and used for this study. After first-pass review of vaccine hesitancy narratives using NVivo Version 10.0 software, themes were identified, agreed upon and revised. Themes included: physician approach to vaccine refusal, patient-provider communication, physician attitude toward vaccine-refusing parents, and student response to encounter.
Results: Of 19 narratives addressing vaccine hesitancy, 16 students commented on positive physician professionalism attributes and 13 felt they learned how to best approach these encounters. Seven noted the ability of the preceptor to remain calm in the face of frustration. Two felt a sense of failure after the encounter and five described scenarios in which they hoped they would perform better than the observed physician. Eleven students applied ethical concepts in their reflections about vaccine hesitancy.
Discussion: Student reflections of patient encounters involving parental vaccine hesitancy provided insight into the student experience of the impact of physician communication, patient education and approaches to the learning experience. Patient-provider discussions regarding vaccine refusal may provide a mechanism for modeling communication skills and professionalism. A brief post-encounter checklist to assess student understanding and emphasize key teaching points is proposed. Taking the time to discuss these encounters with students may benefit providers, students, and patients.