The learning effects of different presentations of worked examples on medical students' breaking-bad-news skills: A randomized and blinded field trial

Abstract

Objectives: Effective instructional approaches are needed to enable undergraduates to optimally prepare for the limited training time they receive with simulated patients (SPs). This study examines the learning effects of different presentation formats of a worked example on student SP communication.

Methods: Sixty-seven fourth-year medical students attending a mandatory communication course participated in this randomized field trial. Prior to the course, they worked through an e-learning module that introduced the SPIKES protocol for delivering bad news to patients. In this module, a single worked example was presented to one group of students in a text version, to a second group in a video version, and to a third group in a video version enriched with text hints denoting the SPIKES steps.

Results: The video-with-hints group broke bad news to SPs significantly more appropriately than either of the other groups. Although no further condition-related effects were revealed, students who learned from the text version most frequently (although non-significantly) ignored unpleasant emotions (standardised emotional cues and concerns) expressed by the SPs.

Conclusions: The learning effect was strongest when the video-based worked example was accompanied by hints.

Practice implications: Video-related learning approaches that embed attention-guiding hints can effectively prepare undergraduates for SP encounters.

Keywords: Breaking-bad-news skills learning; Emotional cues and concerns; Hints; Presentation format; Randomized field trial; Simulated patient encounter; Worked examples.