Using simulated interviews to teach junior medical students to disclose the diagnosis of cancer

Abstract

Background: Disclosing cancer is a difficult task for junior doctors.

Methods: We conducted a survey of 4th-year (of 6 years) medical students' (N = 50) expectations of training in breaking bad news and then designed a course for students in their 5th-year oncology clerkship. The course comprised (a) a group discussion that taught a 6-point protocol for delivering a diagnosis (N = 40), (b) a videotaped simulated interview with actors to assess protocol implementation and communication skills (N = 18), and (c) feedback from a senior physician. The impact of the course was assessed during the end-of-year faculty examination (N = 55).

Results: Most students considered breaking bad news most difficult for the diagnosis of cancer or neurodegenerative disease and desired appropriate training. Their primary concerns were attitude and choice of words. During the interview, their greatest difficulty was asking patients what they want to know. In the end-of-year examination, students who took part in both the group discussion and a simulated interview did significantly better in remembering items of the 6-point protocol than those who had only taken part in the group discussion.

Conclusion: This pilot study shows that our course improves students' knowledge in breaking bad news such as cancer. However, its effectiveness after graduation still needs to be determined. Assessing knowledge is feasible using interviews with simulated patients in France.