A Breaking Bad News Exercise to Assess Student Competence Prior to Graduation

Abstract Introduction Students entering a Capstone course, at the time of graduation, have experience witnessing and delivering forms of bad news, the most common of which involves angry or upset families and topics of prognosis/diagnosis. Methods This is a breaking bad news exercise for graduating medical students which utilizes a standardized patient (SP) acting as a family member during a complex hospitalization. Students take turns meeting with a family member at multiple times during a single patient's hospitalization to discuss changes in the patient's condition. Direct observation by peers and faculty allow for assessment of student competence using the Transitional Year Milestones. Short written reflections offer insight into student learning about the impact of human emotions on encounters between patients and providers. Results Students enjoyed the opportunity to practice more advanced communication skills near the time of graduation and 85% of students said this exercise prompted self-reflection and resulted in new learning. Students also reported that the use of silence is the skill with which they feel the most comfortable using after this exercise, though more than 80% of students also felt skilled with reflecting emotions, using “I wish” statements, and “ask-tell-ask.” When prompted to reflect on the impact of difficult conversations on patients and their families, 90% of students wrote comments that fall within the competency domain of Interpersonal Skills and Communication #7: “Demonstrate insight and understanding about emotions and human responses to emotions that allow one to develop and manage interpersonal interactions.” Discussion The exercise is unique in that it follows a patient's family through several encounters, allowing the students to see the repeated impact of these conversations on the family over time. The various evaluation methods over the years of implementation have shown this multi-encounter technique to be effective in helping students work towards competence in interpersonal and communication skills.