Simulation-based training help docs break bad news to patients

During training, future doctors learn to avoid medical jargon so patients understand all issues involved in their diagnosis, while at the same time remaining attentive to their needs. (Rawpixel pic)

CHICAGO: At Northwestern University Feinberg School of Medicine in the United States, future doctors are being given simulation-based training to teach them how to communicate bad news and how to accompany patients in the trying moments when they first hear it.

Announcing to someone that they are suffering from a serious illness, or telling loved ones about the death of a patient is an important responsibility for doctors and one that requires delicate handling. What is the right distance to adopt, and what are the right words to use to avoid frightening patients unduly?

These are all issues that require a specific programme, such as the one offered to students at Northwestern University’s Feinberg School of Medicine.

In this simulation-based training course, future doctors learn how to choose appropriate words and avoid medical jargon to ensure patients understand all the issues involved in their diagnosis, while at the same time remaining attentive to their reactions and emotions.

“We know patients and families remember these conversations forever. It’s better to practice these skills in a simulated environment where no one is harmed so that when you do it in real life, people will understand the news, their next steps and know they have a partner in this,” explains the lead author of the study, Dr Julia Vermylen, an assistant professor of medicine and medical education at Feinberg.

The course clearly helped students to improve their communication skills

The effectiveness of the course was subjected to a test, the results of which have now been detailed in the journal Academic Medicine.

The programme described in the publication was offered to 85 medical interns enrolled in their fourth year at the Feinberg faculty. Of these, 79 completed the entire course.

To evaluate their communication skills, the trainers organised individual video simulations in which the students had to tell a fictitious patient that his or her headaches were caused by a brain tumour.

Although 70% of the students reported that they had already had to deliver bad news in real-life situations, the trainers judged their communication skills to be insufficient.

“One mistake students often make is they get so focused on the medical information that they forget to recognise the emotional impact of the news on the patient,” points out Dr Gordon Wood, an associate professor of medicine and medical education who took part in the program.

“When someone hears bad news, there usually is a flood of emotions and, if the doctor keeps talking about medical information in that moment, patients often report that they didn’t hear anything that was said,” the trainer added.

After the training course, the students did another video simulation to evaluate their progress, in which they once again had to deliver bad news to an actor playing the role of a patient.

“The doctor needs to serve all those needs of information, guidance and emotional support. We teach a general framework and set of skills, then use the simulations to practice applying it in different situations,” explains Dr. Wood.

Each of the students were allowed to progress at his or her own pace, with additional simulations until they acquired all of the skills being taught.

At the end of the course, students’ overall performance had increased significantly, from an average of 65% to 94.2%, the study found.