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Randomized Controlled Trial
. 2019 Oct 14;20(6):893-902.
doi: 10.5811/westjem.2019.8.43441.

Efficacy of a Short Role-Play Training on Breaking Bad News in the Emergency Department

Jean-Christophe Servotte  1   2 , Isabelle Bragard  1   2 , Demian Szyld  3 , Pauline Van Ngoc  1 , Béatrice Scholtes  1 , Isabelle Van Cauwenberge  4 , Anne-Françoise Donneau  1 , Nadia Dardenne  1 , Manon Goosse  1 , Bruno Pilote  5 , Michèle Guillaume  1 , Alexandre Ghuysen  1   2
Affiliations
Randomized Controlled Trial

Efficacy of a Short Role-Play Training on Breaking Bad News in the Emergency Department

Jean-Christophe Servotte et al. West J Emerg Med. .

Abstract

Introduction: Breaking bad news (BBN) in the emergency department (ED) represents a challenging and stressful situation for physicians. Many medical students and residents feel stressed and uncomfortable with such situations because of insufficient training. Our randomized controlled study aimed to assess the efficacy of a four-hour BBN simulation-based training on perceived self-efficacy, the BBN process, and communication skills.

Methods: Medical students and residents were randomized into a 160-hour ED clinical rotation without a formal BBN curriculum (control group [CG], n = 31) or a 156-hour ED clinical rotation and a four-hour BBN simulation-based training (training group [TG], n = 37). Both groups were assessed twice: once at the beginning of the rotation (pre-test) and again four weeks later. Assessments included a BBN evaluation via a simulation with two actors playing family members and the completion of a questionnaire on self-efficacy. Two blinded raters assessed the BBN process with the SPIKES (a delivery protocol for delivering bad news) competence form and communication skills with the modified BBN Assessment Schedule.

Results: Group-by-time effects adjusted by study year revealed a significant improvement in TG as compared with CG on self-efficacy (P < 0.001), the BBN process (P < 0.001), and communication skills (P < 0.001). TG showed a significant gain regarding the BBN process (+33.3%, P < 0.001). After the training, students with limited clinical experience prior to the rotation showed BBN performance skills equal to that of students in the CG who had greater clinical experience.

Conclusion: A short BBN simulation-based training can be added to standard clinical rotations. It has the potential to significantly improve self-efficacy, the BBN process, and communication skills.

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Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.

Figures

Figure 1
Figure 1
Flowchart of study examining the effect of simulation training on how trainees deliver bad news. BBN, breaking bad news; BBNSBT, BBN simulation-based training; h, hour; ED, emergency department.
See this image and copyright information in PMC

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