Standardized Patients Versus Peer Role Play—Exploring the Experience, Efficacy, and Cost-Effectiveness in Residency Training Module for Breaking Bad News

Abstract

Delivering bad news is a difficult task for the clinician and one that is important to address and nurture in residency training. Residents were assigned to receive communication training with either standardized patients (SP) or peer role play (RP). Anonymized pre- and post-questionnaires were filled by residents detailing their experience. Independent assessors blinded to the study hypothesis rated the residents' performance using a standardized plus-delta assessment form as a measure of effectiveness of either methods. In our study additionally, corresponding costs were assessed as man-hours resulting from the hours of work of SP, RP, and tutors in order to generate the incremental cost-effectiveness ratio for the use of SP against the use of RP. The study took place in a tertiary academic hospital, National University Hospital, Singapore. A total of 15 junior residents in anesthetic training entered and completed the study and were evaluated during the 2017-2018 academic year. The mean performance scores were 63.3% (RP group) and 74.3% (SP group) attributing advantage to the SP group. Costs however were slighter greater in the SP group (14 man-hours) versus (10 man-hours) in the RP group. The resulting incremental cost-effectiveness ratio was 0.36 man-hours per 1-point increase in the performance score when comparing SP to peer RP. SPs proved to be the more cost-effective modality when employing communication training for delivering bad news. The successful experience and use of SPs should be balanced against the marginally lesser costs involved in peer RP in planning residency teaching sessions.