Breaking bad news: medical undergraduate communication skills teaching and learning

Knox, J. D. E.; Thomson, Gill

doi:10.1111/j.1365-2923.1989.tb01541.x

Cited by 23 publications

(18 citation statements)

References 2 publications

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“…7 One innovative program designed for undergraduate medical students used two 2-hour sessions in both inpatient and outpatient settings, interviews with parents, and play with child patients to enable students to better understand family perspectives about communication. 113 Progressive experiences included a small-group discussion about the difficulties of breaking bad news, a video role model followed by a parent panel, and finally, time to meet the child patient. The training was favorably received by student, parent, and patient participants.…”

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confidence: 99%

Communicating With Children and Families: From Everyday Interactions to Skill in Conveying Distressing Information

Levetown¹

2008

Pediatrics

396

291

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Health care communication is a skill that is critical to safe and effective medical practice; it can and must be taught. Communication skill influences patient disclosure, treatment adherence and outcome, adaptation to illness, and bereavement. This article provides a review of the evidence regarding clinical communication in the pediatric setting, covering the spectrum from outpatient primary care consultation to death notification, and provides practical suggestions to improve communication with patients and families, enabling more effective, efficient, and empathic pediatric health care. INTRODUCTION/OVERVIEWHealth care communication is a critical, but generally neglected, component of pediatric and pediatric subspecialty practice and training and is a skill that can and must be taught. [1][2][3][4][5][6][7][8][9][10][11][12][13] The practicing clinician's ability to communicate openly and with compassion is essential for effective and efficient routine health care; this ability becomes a vital lifeline for parents and children confronted with lifealtering and sometimes life-ending conditions. [13][14][15][16] The purpose of this report is to provide research-based and practical guidance to enable effective communication with pediatric patients and their families in a number of common settings and situations. Although child abuse, sexuality, divorce, and many other situations are not individually addressed, the principles and approaches discussed apply equally to these situations.Communication is the most common "procedure" in medicine. Health care communication is different from normal social discourse, because intimate and very private issues are often discussed. These include hopes and fears, developmental concerns, sexuality, and mental health disorders. Painful issues, such as abuse, school failure, drug use, and terminal illness, are also discussed. Communication is the foundation of the therapeutic relationship; it is the basis of fiduciary and ethical obligations of physicians to patients and their families. Effective health care communication is an essential tool for accurate diagnosis [17][18][19] and for the development of a successful treatment plan, 20-23 correlating with improved patient knowledge, 15,24 functional status, 25,26 adherence to the agreed-on treatment regimen, 20,21,27-32 improved psychological and behavioral outcomes, 15,33-36 and even reduced surgical morbidity. 3,4,37 In the case of distressing news, skillful communication can enable a family to adapt better to a challenging situation, 12,38,39 including a child's unanticipated impairments. [40][41][42][43] Poor communication, on the other hand, can prompt lifelong anger 31,42,44-48 and regret, 14,40 can result in compromised outcomes for the patient and family, and can have medicolegal consequences for the practitioner. 49

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confidence: 99%

Communicating With Children and Families: From Everyday Interactions to Skill in Conveying Distressing Information

Levetown¹

2008

Pediatrics

396

291

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“…Specifically for "Jenny" students commented at the end of class how much they enjoyed the opportunity to apply communication and history-taking skills in this real-life, challenging, yet rewarding, experience similar to the findings in other studies [11,15,16,22] . They also reported that interacting with a real patient made more of an impact on their learning and commented on how much more difficult it was to keep the health interview focused than they had anticipated.…”

Section: Student Class Evaluations (Formative)mentioning

confidence: 53%

“…Students need one-to-one, hands-on patient care to acquire the skills for direct care, as reflected by the large number of required clinical hours in their training. Having patients teach medical and nursing students is more common outside the US, particularly in the United Kingdom (UK) [11][12][13][14][15][16][17][18] . Clinical medical education has also employed patients passively as cases and exemplars since the 1960s [9] .…”

Section: Patients As Passive Educatorsmentioning

confidence: 99%

“…Patient educators may teach medical students clinical skills such as communicating or clinical interviewing developing interviewing skills in psychiatry, and communicating bad news to patients and families [11,15,16] .…”

Section: Patients As Active Educatorsmentioning

confidence: 99%

“…Simultaneously, students learned to appreciate the challenges of succinctly and clearly documenting a long, detailed and sometimes rambling history. They quickly recognized the difficulties of completing a thorough history of an elder in a timely fashion; they came to understand the value of scheduling several appointments (or visits to the bedside) to gather information, and the challenges of gaining a focused history while engaging a patient to tell their story [11,15,16,22] . Thus, this teaching strategy pulled together many important teaching points about the process of health assessment and about caring for the elderly population.…”

Section: Processmentioning

confidence: 99%

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Patients as educators: Contemporary application of an old educational strategy to promote patient-centered care

Terrien

Hale

2014

JNEP

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Patients first. Patient-centered care. Patient-centered medical homes. The patient experience. Today, it is hard to miss the appeal for patient-centered care in US health care reform, as well as in national and professional publications. If patients are the focus, shouldn't they formally contribute to nursing and other health professions education? The earlier in their education students understand patients' perspectives, the better they can integrate patients' reality into their practice. Experiencing the health care maze through the perspective of a patient or family living with disability, cancer, chronic disease, or dementia has an indelible impact on a learner's practice. While simulation, standardized patients, and problembased learning are excellent educational strategies, patients as teachers in the classroom creatively, efficiently, and memorably bring life to multiple concepts and content areas far more effectively than an abstract case, lecture, and/or bulleted slides. This article presents a brief history of patient teachers, and the authors' experiences of integrating them into the nursing curriculum. Students enjoyed learning, participated enthusiastically, and evaluated these classes at the highest level. Patients found teaching empowering and were proud to teach future nurses.

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