Effects on Medical Students of Longitudinal Small-Group Learning about Breaking Bad News

Breaking bad news: an active learning method for medical students

BACKGROUND

Breaking bad news is one of the most difficult aspects of communication in medicine. The objective of this study was to assess the relevance of a novel active learning course on breaking bad news for fifth-year students.

METHODS

Students were divided into two groups: Group 1, the intervention group, participated in a multidisciplinary formative discussion workshop on breaking bad news with videos, discussions with a pluri-professional team, and concluding with the development of a guide on good practice in breaking bad news through collective intelligence; Group 2, the control group, received no additional training besides conventional university course. The relevance of discussion-group-based active training was assessed in a summative objective structured clinical examination (OSCE) station particularly through the students' communication skills.

RESULTS

Thirty-one students were included: 17 in Group 1 and 14 in Group 2. The mean (range) score in the OSCE was significantly higher in Group 1 than in Group 2 (10.49 out of 15 (7; 13) vs. 7.80 (4.75; 12.5), respectively; p = 0.0007). The proportion of students assessed by the evaluator to have received additional training in breaking bad news was 88.2% (15 of the 17) in Group 1 and 21.4% (3 of the 14) in Group 2 (p = 0.001). The intergroup differences in the Rosenberg Self-Esteem Scale and Jefferson Scale of Empathy scores were not significant, and both scores were not correlated with the students' self-assessed score for success in the OSCE.

CONCLUSION

Compared to the conventional course, this new active learning method for breaking bad news was associated with a significantly higher score in a summative OSCE. A longer-term validation study is needed to confirm these exploratory data.

Oral cancer diagnosis communication: Impact of an educational intervention using the SPIKES protocol

OBJECTIVE

This study evaluated the influence of a single educational intervention on the perception and knowledge of strategies for communicating oral cancer diagnoses.

METHODS

A educational intervention, 72 dentists and 41 dental undergraduates participated in the 'Maio Vermelho Project', a continuing education activity. Participants completed a 14-question online questionnaire concerning their experiences and perceptions of delivering difficult news. The educational intervention featured an interview illustrating the SPIKES protocol, broadcast on YouTube.

RESULTS

Participants had a mean age of 40 years. A minority (21.2%) had encountered or experienced communicating an oral cancer diagnosis. Exposure to lectures on this topic during their education was uncommon (22.1%) but more prevalent among students. After the intervention, confidence in communicating a cancer diagnosis (29.2%) and addressing the patient's family (30.1%) in line with the SPIKES protocol increased.

CONCLUSION

A training deficit persists in delivering cancer diagnoses, highlighting the need for educational interventions to empower students and professionals in this critical procedure. Integration of this topic into the dental undergraduate curriculum is imperative.

CLINICAL RELEVANCE

Effectively communicating a cancer diagnosis poses challenges to healthcare professionals, impacting treatment outcomes. Implementing educational interventions ensures that professionals are well prepared to navigate this complex task, ultimately improving patient care.

EMBRACE (Empowering Medical students' skills in BReaking bAd news with Compassion and Empathy) module improves the skills of undergraduate medical students in effectively breaking the bad news: a case-control study

Effective communication skills are pivotal in health care, particularly when conveying distressing information to patients and their families. However, medical education still lacks the adoption of a universal model that can be incorporated into the curricula to train and assess students in effectively communicating with patients. This study aims to assess the impact of training undergraduate medical students to deliver bad news effectively using the Empowering Medical students' skills in BReaking bAd news with Compassion and Empathy (EMBRACE) module. This randomized case-control study involved medical students from the first, second, and third professional years (study group, n = 75; control group, n = 75). For the study group, the EMBRACE modules were distributed. Then, a 1-hour training session on effectively delivering bad news was followed by a multiple-choice question test and objective structured clinical examination with response, interpretation, and communication skills stations. Participants' feedback was obtained on a five-point Likert scale. There was a highly significant improvement in knowledge and skills among the study group compared to controls with a P value less than 0.0001. Of the participants, 98.76% perceived that the training equipped them with practical skills, and 98.77% felt that the facilitator had demonstrated the steps of delivering bad news clearly and effectively. Only 4.44% of participants were confident in effectively interacting with patients before the session, and an overwhelming 81.11% gained confidence in their communication skills after the training. With demonstrated significant improvement in knowledge and skills, this study supports the adoption of EMBRACE modules in undergraduate medical education, ultimately improving patient experiences, doctor-patient relationships, and health outcomes.NEW & NOTEWORTHY The Empowering Medical students' skills in BReaking bAd news with Compassion and Empathy (EMBRACE) module is noteworthy for its holistic approach to training medical students in the delicate art of delivering distressing news to patients. It not only incorporates the evidence-based setting, perception, invitation, knowledge, emotions, and strategy (SPIKES) method but also distinguishes itself by providing real-life conversation examples and self-assessment cases, which make the training highly relatable and practical for students to actively engage in their learning and personal development.

Delivering bad or difficult news. An innovative simulation-based education approach to prepare interdisciplinary fellowships

BACKGROUND

There is limited data on the effectiveness of training interventions to improve the delivery of bad news.

METHODS

This preliminary research included pre-post assessments and an open-ended survey to evaluate the effectiveness and perceived value of training on delivering bad news for 26 first- and second-year fellows from five adult and pediatric fellowship programs.

RESULTS

There was a significant increase in faculty assessment scores (34.5 vs. 41.0, respectively, Z = -3.661, p < 0.001) and Standardized Patient (SP) assessment scores (37.5 vs .44.5, respectively, Z = -2.244, p = 0.025). Fellows valued having a standard framework to aid in the delivery of bad news; receiving targeted feedback and having the opportunity to apply their skills in a subsequent case.

CONCLUSIONS

A one-hour, four-phase lesson plan that includes an individualized training approach and simulation do-overs can be effective and valuable for preparing fellows to deliver bad news.

How to break bad news and how to learn this skill: results from an international North-Eastern German Society for Gynecological Oncology (NOGGO) survey among physicians and medical students with 1089 participants

BACKGROUND

Delivering bad news to patients is one of the most challenging tasks in medical practice. Despite its great relevance to patients, relatives, and medical staff, there is a paucity of data pertaining to training, experience, expectations, and preferences of physicians and medical students on breaking bad news.

METHODS

We conducted an international survey in Germany, Switzerland, and Austria using an online questionnaire among physicians and medical students.

RESULTS

A total of 786 physicians and 303 medical students completed the survey. Physicians stated that 32.7% deliver bad news several times a week and 45.2% several times a month. Difficulties controlling their emotions (35.1%) and remaining professional (43.4%) were the greatest challenges for physicians. Delivering bad news is associated with feelings of anxiety, both among experienced physicians (median of 3.8 out of 10.0) and medical students (median of 5.3). Conveying bad news is a burden to physicians and consequently has a substantial impact on their job satisfaction. All participants reported the need for more communication training concerning this subject. Only 49.5% of medical students and 67.3% of physicians mentioned having learned adequate communication skills. Our data demonstrate that communication training decreases the level of anxiety and increases the feeling of self-confidence towards breaking bad news. Preferred educational tools were seminars with simulation (students: 71.4%, physicians: 49.5%), observing more senior faculty (students: 57.4%, physicians: 55.1%), and supervision and feedback sessions (students: 36.3%, physicians: 45.7%). The largest barriers regarding education on communication were limited time (students: 77.0%, physicians: 74.9%) and missing awareness of supervisors (students: 60.6%, physicians: 41.1%).

CONCLUSIONS

Our study showed a great need for systematic training and education in breaking bad news among physicians and medical students. Hospitals, medical schools, and postgraduate training programs are strongly encouraged to fill this gap, and improve sustainable doctor-patient communication to overcome the psychological burden for physicians.

Evaluating the Effectiveness of the SPIKES Model to Break Bad News - A Systematic Review

Introduction: Breaking bad news to patients and families can be challenging for healthcare providers. The present study conducted a systematic review of the literature to determine if formal communication training using the SPIKES protocol improves learner satisfaction, knowledge, performance, or system outcomes. Method: MEDLINE, Embase, CINAHL Plus (Nursing & Allied Health Sciences), and PsycINFO Databases were searched with keywords BAD NEWS and SPIKES. Studies were required to have an intervention using the SPIKES model and an outcome that addressed at least one of the four domains of the Kirkpatrick model for evaluating training effectiveness. The Cochrane Risk of Bias Tool was used to conduct a risk of bias assessment. Due to heterogeneity in the interventions and outcomes, meta-analysis was not undertaken and instead, a narrative synthesis was used with the information provided in the tables to summarise the main findings of the included studies. Results: Of 622 studies screened, 37 publications met the inclusion criteria. Interventions ranged from the use of didactic lecture, role play with standardised patients (SPs), video use, debriefing sessions, and computer simulations. Evaluation tools ranged from pre and post intervention questionnaires, OSCE performance with rating by independent raters and SPs, and reflective essay writing. Conclusions: Our systematic review demonstrated that the SPIKES protocol is associated with improved learner satisfaction, knowledge and performance. None of the studies in our review examined system outcomes. As such, further educational development and research is needed to evaluate the impact of patient outcomes, including the optimal components and length of intervention.

Delivering Bad News: Emotional Perspective and Coping Strategies of Medical Students

Purpose

The aim of our study was to analyze students' emotional experiences and coping mechanisms regarding the situation of delivering bad news (DBN).

Patients and Methods

291 fifth- and sixth-year students from 14 medical universities took part in our study. Their responses were analyzed from the perspective of their experience - whether the individuals received bad news, delivered bad news themselves, witnessed bad news being delivered, or had no experience at all. We used content analysis (CA) to examine the responses and analyzed classified variables using χ2 tests, logistic regression, and predictive modeling with multiple correspondence analysis (MCA).

Results

Students who had experience as a deliverer were more likely to experience failure and guilt (p=0.005). Predictions of anxiety (59.3%), stress (41.9%), and sadness (33.7%) were the highest in the students with no DBN experience. These students were most likely to make statements suggesting lack of methods and strategies for coping with difficult emotions. Students, who were immersed in DBN experiences, more often expressed the need to talk about their emotions with an experienced doctor, a family member or a friend, and used those conversations as a coping strategy.

Conclusion

The most important aspects that influence the quality of delivering bad news are both communication skills and emotional context. Training regarding DBN should not only contain those two elements, but also consider the development of coping mechanisms.

Delivering Bad News: Self-Assessment and Educational Preferences of Medical Students

BACKGROUND

Numerous reports indicate the educational deficiencies of medical students in delivering bad-news-related skills. Evaluation of the performance of training programs in this area should be one of the key components of the educational process. The purpose of this study was to analyze medical students' preferences and educational needs regarding DBN (delivering bad news). The effect of clinical experience on the self-assessment of skills was analyzed.

METHODS

The quantitative survey was conducted using the CAWI technique. The study involved 321 fifth- and sixth-year medical students from 14 medical universities in Poland. Pearson's χ2 test was used for statistical analysis. The profile of respondents for categorical variables was determined by KMeans analysis.

RESULTS

As many as 75.1% of students revealed that they did not feel sufficiently prepared for DBN. Only 18.7% reported having adequate competence in this area. More than half of the inquired students (63.6%) witnessed a situation during their clinical practice in which a physician provided a patient with information about an unfavorable diagnosis. These students were less likely to declare that they could not deliver BN (43.4%) than students who had no such experience (58.2%). As many as 86.3% of the respondents reported the need for more time in DBN skills training. Students mostly preferred active teaching methods.

CONCLUSIONS

Understanding students' learning needs and preferences can help medical schools optimize their education programs to develop DBN-related competencies.

A Survey of Norwegian Nursing Students' Responses to Student-Centered Small Group Learning in the Study of Human Anatomy and Physiology

Introduction

Small group learning (SGL) is a main learning strategy in the study of bioscience subjects in nursing schools.

Objectives

We evaluated Norwegian nursing students' responses to the student-centered SGL approach in the study of anatomy and physiology (A&P) and tried to determine what aspects educators should improve regarding the use of SGL in the study of biosciences.

Methods

A descriptive questionnaire survey was conducted to evaluate Norwegian nursing students' responses and experiences, for example, motivation, performance, satisfaction, and effectiveness of this new SGL strategy in the study of human A&P.

Results

Nursing students showed a high motivation and varied experience, for example, different attendance rates, satisfaction, and effectiveness in response to the student-centered SGL strategy in the study of human A&P. In addition, some students reported a low completion rate of assigned work for each SGL session. Additional concerns were collected in the open-end survey section. Subsequent thematic analysis of these comments identified that SGL arrangement and teacher tutorials were the main themes that needed to be improved in future SGL practice.

Conclusions

The information from this survey might provide new insights to educators to understand what and how we should improve the student-centered SGL work in future teaching practice.