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Background: Breaking bad news is one of the complex communication skills essential to the practice of every clinician. It involves not only the mere provision of information, but also how to deal with the emotions of the patients and the response of their relatives. Therefore, certain protocols are employed for this process, including "BREAKS", "SPIKES", and “ABCDE” protocols. The emergence of the COVID-19 pandemic mandated the use of strict infection control measures including social distancing, requiring the utilization of telecommunication technologies for breaking bad news. Objective: The aim of the study was to assess the use on non-physical methods in breaking bad news by physicians and to evaluate the need for more development and training. Methods: Cross-sectional survey conducted in Kufa Medical College Al-Najaf during April - June 2021, and included 60 physicians of various specialties working in that hospital. Results: Majority of participants 88.3% reported breaking bad news regularly. Less than half of participants 46.7% received training on breaking bad news, and only 13.3% received training on non-physical breaking bad news. More than half of participants mentioned that showing empathy is the area that needs improvement the most. Conclusion: High proportion of physicians lacks the necessary skills to break bad news, especially using non-physical ways during the pandemic. Well-structured programs are needed for the training of healthcare providers on breaking bad news, with certain adaptations for traditional protocols to be appropriate for telephone or video conferencing.

Background: There are three undergraduate medical school curricula types - ‘traditional’, ‘integrated’, and ‘problem-based learning’ (PBL). Traditional curricula involve teaching basic medical science in the early years in an atomistic and often didactic way, predominantly through lectures. In later years, students move on to learning clinical skills and applying their medical knowledge in clinical settings. Meanwhile, the philosophy of integrated curricula is that students learn best by understanding medical science in relation to whole systems and by linking knowledge with practice. Integrated curricula take a more holistic approach and bring together elements of medical science rather than teaching them in isolation. Objective: The study aimed to measure and compare perceptions of the learning environment between two cohorts of medical students at a medical school in Iraq. The intention was to explore differences in perceptions between those following a traditional surgical curriculum and those following an innovative, integrated curriculum and thereby add to the body of evidence looking at the impact of the two surgical curriculum models on the learning environment. Methods: The Dundee Ready Educational Environment Measure (DREEM) was used to measure students’ perceptions of their learning environment. The unpaired t-test was used to compare the mean scores of two cohorts of medical students. Results: The global mean score for the students following the integrated curriculum was higher than the global mean scores for the group studying the traditional curriculum. This difference is statistically significant. The mean scores for the integrated curriculum students are higher than those of the traditional curriculum students for all sub-sets of the measure. The difference is statistically significant for one sub-set, ‘Students’ Perceptions of Learning,’ and the difference is close to being statistically significant for the ‘Students’ Perception of Teachers’ sub-set. Conclusion: The results reflect those from other international studies and add to the body of evidence that suggests that innovative, integrated curricula are a critical factor in promoting a more positive learning environment than that generated within a traditional curriculum model.

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