A standardized low-cost peer role-playing training intervention improves medical student competency in communicating bad news to patients in Botswana.

Elizabeth D Lowenthal,Erik Isaksson,Bernhard A Fassl,Francis M Banda,Katherine D Westmoreland,Andrew P Steenhoff

doi:10.1017/s1478951518000627

Abstract

The purpose of this study was to demonstrate effectiveness of an educational training workshop using role-playing to teach medical students in Botswana to deliver bad news. A 3-hour small group workshop for University of Botswana medical students rotating at the Princess Marina Hospital in Gaborone was developed. The curriculum included an overview of communication basics and introduction of the validated (SPIKES) protocol for breaking bad news. Education strategies included didactic lecture, handouts, role-playing cases, and open forum discussion. Pre- and posttraining surveys assessed prior exposure and approach to breaking bad news using multiple-choice questions and perception of skill about breaking bad news using a 5-point Likert scale. An objective structured clinical examination (OSCE) with a standardized breaking bad news skills assessment was conducted; scores compared two medical student classes before and after the workshop was implemented.ResultForty-two medical students attended the workshop and 83% (35/42) completed the survey. Medical students reported exposure to delivering bad news on average 6.9 (SD = 13.7) times monthly, with 71% (25/35) having delivered bad news themselves without supervision. Self-perceived skill and confidence increased from 23% (8/35) to 86% (30/35) of those who reported feeling "good" or "very good" with their ability to break bad news after the workshop. Feedback after the workshop demonstrated that 100% found the SPIKES approach helpful and planned to use it in clinical practice, found role-playing helpful, and requested more sessions. Competency for delivering bad news increased from a mean score of 14/25 (56%, SD = 3.3) at baseline to 18/25 (72%, SD = 3.6) after the workshop (p = 0.0002).Significance of resultsThis workshop was effective in increasing medical student skill and confidence in delivering bad news. Standardized role-playing communication workshops integrated into medical school curricula could be a low-cost, effective, and easily implementable strategy to improve communication skills of doctors.

Highlights

Delivering bad news is a task that doctors encounter daily in most medical practices (Alelwani & Ahmed, 2014), and even more frequently in low- and middle-income countries (LMIC) where morbidity and mortality are high
Competency in breaking bad news was improved in the cohort of students that had completed the communication training compared with an earlier cohort of students that did not have the training, as shown by the end-of-the-year objective structured clinical examination (OSCE) examination results
We showed that 23% of the University of Botswana medical students had no standardized method to deliver bad news before the workshop, and other studies found similar rates at 23%–52% (Baile et al, 2000; Pereira et al, 2017)

Summary

Introduction

Delivering bad news is a task that doctors encounter daily in most medical practices (Alelwani & Ahmed, 2014), and even more frequently in low- and middle-income countries (LMIC) where morbidity and mortality are high. Breaking bad news is a complex task requiring many skills including communication, responding to emotional reactions, and involving the patient and family members (Baile et al, 2000). The way a serious disease is communicated can have a significant effect on patients’ perceptions about their disease, their health outcome, long-term relationship with their doctor, and both patient and provider satisfaction (Alelwani & Ahmed, 2014; Luttenberger et al, 2014; Rosenbaum et al, 2004). Physicians who are comfortable breaking bad news may be subjected to less stress and lower rates of burnout (Baile et al, 2000; Luttenberger et al, 2014)

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Conclusion