Communication in the conversation between preceptors and physicians-in-training during simulation: what is not said.

Background: There is an abundance of published communication models, but few explicate how professional conversation may the communication of some information but the sharing of one's inner thoughts and feelings. This conceptualization of communication was applied to guide our understanding of how medical learners interact with preceptors at the bedside in a high-fidelity simulation when managing a patient case.

Methods: A total of 84 medical learners (42 residents and 42 medical students) participated in a high-fidelity simulation. After they interacted with the patient for about 10 min, a preceptor entered and offered an equivocal or questionable recommendation about diagnosis or treatment. This type of recommendation was designed to trigger a difficult conversation that would create an opportunity for the learners to share facts, thoughts, points of view, and feelings about the patient with the preceptor. The preceptor left the room, and the learners completed their assessment once they made a diagnosis and treatment recommendations. Two raters independently coded the communication between the preceptor and learners by independently watching video recordings.

Results: Of the three types of communication styles identified in the model, the majority of learners ( = 56, 66.70%) engaged in a muted conversation where they shared little or no clarification of facts about the patient's case, their feelings or thoughts, nor did they explore their preceptor's point of view.

Conclusions: Learners may not feel comfortable exploring or expressing thoughts and feelings in front of their preceptors. We recommend that preceptors directly engage learners in conversation.