APGO

Background: Breaking bad news (BBN) is a necessary, disturbing and not uncommon duty for practicing physicians.  Yet physicians report inadequate training in the skill and educators have little evidence-based guidance for developing a BBN curriculum.

Methods: In 2011-2012 a prospective randomized trial was performed to assess the impact of didactic lecture on student competence and comfort in BBN in a simulated obstetric setting.  After informed consent, 51 medical students were randomized to either receive or not receive didactic instruction prior to simulating disclosure of fetal death.  Student performance was assessed from multiple perspectives: student surveys, simulated patients assessment, and independent video review by three blinded professionals.

Results: While no improvement in student comfort was demonstrated after a didactic lecture, there was a significant improvement in knowledge (p=0.009).  Correspondingly, the simulated patients’ evaluations demonstrated a small to medium effect size in the students ability to impart knowledge and information to the patient (-0.37) and to provide an appropriate summary and follow up (-0.43).  Video review indicated a significant improvement in student ability to assess the patient perception of their clinical situation and to obtain an invitation prior to giving bad news in the lecture group, compared to the control (p=.002). Video assessment score showed a medium effect size overall in delivery of bad news (-0.52)

Discussions: Didactic lecture is effective in improving students’ knowledge and competence in delivering bad news in a complex environment like obstetrics.  

Keywords: Communication Skills, Curriculum Development/Evaluation, Instructional Materials/Methods, Professionalism