Undergraduate training in breaking bad news: A continuation study exploring the patient perspective

Abstract

Objective: This paper reports on the continuation of an initial study that demonstrated the effectiveness, as rated by experts, of an undergraduate training in breaking bad news (BBN) using simulated patient (SP) and individual feedback. The current study aimed to further explore whether such an individualized training approach also has positive effects from the perspective of the patient, using the analogue patient (AP) methodology. Methods:A subsample of 180 videotaped interviews with SPs were selected from the existing data set (N = 332), consisting of 60 pre-and post-training interviews of students benefiting from the individualized approach (intervention group) and 60 post-training interviews of students having small-group SP training and collective supervision (comparison group). Sixty-eight APs-healthy untrained observers-were asked to view the videotaped interviews while "putting themselves in the patient's shoes" and evaluate satisfaction, trust, liking, and the competence of medical students. Results:The intervention group students improved significantly from pre-to posttraining on several dimensions evaluated by the APs: patient satisfaction, trust in the student, liking of the student, and perceived medical competence. Increased AP satisfaction was related to different changes in students' communication behavior between pre-and post-training: increase in positive talk, emotional responsiveness, biomedical and psychosocial information, and biomedical counseling. There was no significant between-group difference at post-training.Conclusions: AP evaluation showed significant improvement between pre-and post-training. This result provides additional and complementary evidence of the positive effects of individualized training in BBN from the AP perspective, a proxy of (real) patients. KEYWORDSbreaking bad news, cancer, communication training, medical students, oncology, patient outcome Valerie Carrard and Céline Bourquin contributed equally to the present study and are both considered first authors.

Virtual patient simulation in breaking bad news training for medical students

“…At our University, communication teaching is fully implemented with theoretical and practical courses throughout the medical curriculum. The present study focuses on our undergraduate BBN training consisting of a 45-min lecture and a 20-min videotaped training with a simulated patient (SP) for each student, followed by an individual 1-hour supervision with a faculty tutor (described elsewhere [8][9][10]).…”

Development of a new instrument to assess the quality of physicians' delivery of bad news

“…A meta-analysis including 17 articles on interventions involving medical students, residents, and/or physicians demonstrated large improvement in the participants' performance in the OSCE and moderate improvement in selfconfidence 15 . The authors suggested further studies to evaluate the effects of interventions in clinical practice with real patients, which has also been highlighted by other authors [16][17][18][19][20] . One outcome measure should be the patients' perception on how they received BN.…”

“…In order to prepare medical students and physicians for this task, the teaching has combined theory and practice 5 , generally based on frameworks that systematize the key steps of BN delivery [6][7][8] . Studies on the effects of interventions have included outcome measures such as the participants' subjective aspects (satisfaction, self-confidence, and comfort), 9 knowledge, performance in Objective Structured Clinical Examination (OSCE) rated by observers, standardized patients [10][11][12][13][14][15][16] and/or analogue patients, 17 as well as performance in recorded consultations with real patients in relation to the patients' distress, satisfaction with the consultation, and trust in the physician 18 . Nevertheless, the most effective way to teach and learn utilizing simulated patients in medical education is still unknown 19 .…”

Study protocol for the ETMED-L project: longitudinal study of mental health and interpersonal competence of medical students in a Swiss university using a comprehensive framework of empathy

“…Moreover, communication training courses with simulated patients are conducted from the second to the fifth curriculum year on different topics (eg, history taking, breaking bad news [84][85][86] and motivational interview 87 ). As part of this project, simulated patients will be asked to fill in a grid at the end of the interviews with students that includes the OSCE communication five-item checklist as well as the Jefferson Scale of Patient Perceptions of Physician Empathy 88 (see table 1 for sample items).…”