9 The benefits of early simulated ‘breaking bad news’ communication skills training for 3rd year medical students

Abstract

Introduction Effective communication skills are fundamental to the development of competent doctors and all doctors are required to undertake ‘breaking bad news’ consultations. However medical students often have limited exposure to these conversations and palliative care is traditionally taught in the later clinical years. This study explores the impact of new simulated communication skills training undertaken early in clinical placements. Methods 55 students in their first clinical year, participated in a new training event. In 6 small groups they undertook a 3 hour session which used a modified SBAR model to lead students through ‘breaking bad news’ consultations and DNAR discussions; facilitated with a simulated patient actor. The course was evaluated using an anonymised questionnaire which incorporated qualitative and quantitative elements. Ten point visual analogue scales were used to measure the students’ perception of the event. Analysis of the results after 4 groups had completed the teaching led to an adaptation of the training to incorporate additional scenarios and smaller group work. This was re-evaluated using the same questionnaire. Results All but 2 students (4%) felt the training was appropriate early in their clinical studies. Overall they felt the event was very beneficial with a mean visual analogue score (VAS) of 9.1. The benefit of participating in a scenario was improved following modification of the course (mean VAS 9.5 vs 8.8) but the benefit of observing the scenarios was similar in both groups. Review of the qualitative themes suggested that modification of the course provided benefits of greater student participation and peer feedback. Conclusions Previous studies suggest that students might not gain sufficient experience of difficult conversations. This study shows the benefits of simulation in providing experiential training early in the clinical course. It also demonstrates the need for continuous evaluation of teaching to ensure that learning objectives are maintained.