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Randomized Controlled Trial
. 2018 Mar;40(3):137-146.
doi: 10.1055/s-0037-1621741. Epub 2018 Jan 17.

Improving Perinatology Residents' Skills in Breaking Bad News: A Randomized Intervention Study

Maria Silvia Vellutini Setubal  1 , Maria Ângela Reis Goes Monteiro Antonio  1 , Eliana Martorano Amaral  1 , John Boulet  2
Affiliations
Randomized Controlled Trial

Improving Perinatology Residents' Skills in Breaking Bad News: A Randomized Intervention Study

Maria Silvia Vellutini Setubal et al. Rev Bras Ginecol Obstet. 2018 Mar.

Abstract
in English, Portuguese

Objective: Breaking bad news (BBN) is particularly difficult in perinatology. Previous research has shown that BBN skills can be learned and improved when taught and practiced. This project evaluated whether a structured training session would enhance perinatology residents' skills in BBN.

Methods: This was a randomized controlled intervention study with year 1 to 4 Perinatology residents from a medical school in Brazil, during the 2014/15 school year. A total of 61 out of 100 (61%) eligible residents volunteered to a structured training program involving communicating a perinatal loss to a simulated patient (SP) portraying the mother followed by the SP's immediate feedback, both video recorded. Later, residents were randomly assigned to BBN training based on a setting, perception, invitation, knowledge, emotion and summary (SPIKES) strategy with video reviews (intervention) or no training (control group). All residents returned for a second simulation with the same SP blinded to the intervention and portraying a similar case. Residents' performances were then evaluated by the SP with a checklist. The statistical analysis included a repeated measures analysis of covariance (RM-ANCOVA). Complementarily, the residents provided their perceptions about the simulation with feedback activities.

Results: Fifty-eight residents completed the program. The simulations lasted on average 12 minutes, feedback 5 minutes and SPIKES training between 1h and 2h30m. There was no significant difference in the residents' performances according to the SPs' evaluations (p = 0.55). The participants rated the simulation with feedback exercises highly. These educational activities might have offset SPIKES training impact.

Conclusion: The SPIKES training did not significantly impact the residents' performance. The residents endorsed the simulation with feedback as a useful training modality. Further research is needed to determine which modality is more effective.

Objetivo: É uma tarefa particularmente difícil transmitir más notícias em perinatologia. Habilidades de comunicação podem ser aprendidas, ensinadas e praticadas. O presente estudo avalia se uma sessão de treinamento estruturado para comunicar más notícias ampliaria as habilidades dos residentes de perinatologia. MéTODOS: Estudo de intervenção controlado e aleatorizado com residentes do 1° ao 4° ano do curso de perinatologia de uma faculdade de ciências médicas no ano letivo de 2014/15. Um total de 61 dos 100 residentes elegíveis (61%) voluntariaram-se para um programa de treinamento envolvendo comunicar uma perda perinatal para uma paciente simulada no papel da mãe, seguido do feedback imediato da atriz, ambos filmados. Posteriormente, os residentes foram aleatoriamente designados para um grupo de treinamento em más notícias baseado na estratégia SPIKES e revisão dos vídeos (intervenção) ou para um grupo-controle, sem treinamento. Todos os residentes retornaram numa segunda simulação análoga à primeira, com a mesma paciente simulada cega à intervenção. Avaliou-se as habilidades dos residentes segundo um checklist preenchido pela atriz. A análise estatística incluiu análise de covariância para medidas repetidas (ANCOVA-MR). Os residentes avaliaram a atividade de simulação com feedback.

Resultados: O programa foi completado por 58 residentes. As simulações duraram em média 12 minutos, o feedback 5 minutos, e o treinamento SPIKES entre 1h e 2,5h. Não houve diferença significativa nas atuações dos residentes segundo a paciente simulada (p = 0.55). Os residentes avaliaram a simulação com feedback positivamente. Essas atividades podem ter reduzido o impacto do treinamento SPIKES. CONCLUSãO: O treinamento SPIKES não teve impacto significativo na atuação dos residentes. Os residentes consideraram as simulações com feedback úteis. Mais pesquisas são necessárias para determinar qual modalidade é mais eficaz.

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Conflict of interest statement

The authors declare that there are no conflicts of interest.

Figures

Fig. 1
Fig. 1
Flow diagram: Participants' eligibility, enrollment, first simulation, randomization to intervention or control group, followed by second simulation with the final number analyzed.
Fig. 2
Fig. 2
Standardized Patients' (SPs) checklist mean score of residents' performances.
See this image and copyright information in PMC

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