Abstract
Breaking bad news (BBN) is necessary in medical practice and requires training. The purpose of this study is to evaluate the efficacy and mainly explore the components involved in medical students’ and residents’ performance after a flipped educational intervention to train them to break bad news. A randomized controlled before-after study was conducted with 43 medical students and residents in the intervention group and 41 in the control group. The intervention combined an online multimedia program (DocCom) with a two-hour workshop. BBN performance was assessed at two clinical stations using Objective Structured Clinical Examination and analyzed using a mixed between-within subject analysis of variance. A factor analysis was conducted to analyze the performance by checklist components. The intervention group improved its overall performance in BBN over time (p = 0.000; Eta2 = 0.38) and when compared to the control group (p = 0.01; Eta2 = 0.12). The factor analysis revealed two main components: Factor 1—“giving bad news and responding with empathy”—and Factor 2—“using general communication skills”. Performance analysis by these components revealed that the improvement occurred mainly in Factor 1 (over time, p = 0.000; Eta2 = 0.48, group x time, p = 0.000; Eta2 = 0.38). The intervention combining DocCom Module 33 and a workshop had a moderate effect on the improvement of medical students’ and medical residents’ BBN overall performance in standardized encounters. This improvement was mainly related to communication skills for giving bad news and responding with empathy, in which the intervention effect was large over time and between groups.
Highlights
Breaking bad news (BBN) is necessary in medical practice and has an important effect on both patients and physicians (Baile et al, 2000)
Four medical residents (MR) in the control group (CG) failed to participate in the study; one medical students (MS) and two MR in the intervention group (IG) declined to take part in the intervention
There was no baseline difference between the number of IG (n = 43) and CG (n = 41) participants regarding gender (p = 0.67), age (= 0.77), or participant category (p = 0.74)
Summary
Breaking bad news (BBN) is necessary in medical practice and has an important effect on both patients and physicians (Baile et al, 2000). When BBN is inappropriate, patients and physicians may feel dissatisfaction and discomfort, and physicians may even face malpractice lawsuits (Liu et al, 2015; Langewitz, 2017; Collins et al, 2018). This process requires training, and frameworks have been developed in order to guide physicians and other health professionals in BBN (Baile et al, 2000; Narayanan et al, 2010; Quill et al, 2014; Rat et al, 2018). Feedback on trainees’ performance is strongly recommended jel.ccsenet.org
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