Helping medical students to acquire a deeper understanding of truth-telling

Abstract

ProblemTruth-telling is an important component of respect for patients’ self-determination, but in the context of breaking bad news, it is also a distressing and difficult task.InterventionWe investigated the long-term influence of a simulated patient-based teaching intervention, integrating learning objectives in communication skills and ethics into students’ attitudes and concerns regarding truth-telling. We followed two cohorts of medical students from the preclinical third year to their clinical rotations (fifth year). Open-ended responses were analysed to explore medical students’ reported difficulties in breaking bad news.ContextThis intervention was implemented during the last preclinical year of a problem-based medical curriculum, in collaboration between the doctor–patient communication and ethics programs.OutcomeOver time, concerns such as empathy and truthfulness shifted from a personal to a relational focus. Whereas ‘truthfulness’ was a concern for the content of the message, ‘truth-telling’ included concerns on how information was communicated and how realistically it was received. Truth-telling required empathy, adaptation to the patient, and appropriate management of emotions, both for the patient's welfare and for a realistic understanding of the situation.Lessons learnedOur study confirms that an intervention confronting students with a realistic situation succeeds in making them more aware of the real issues of truth-telling. Medical students deepened their reflection over time, acquiring a deeper understanding of the relational dimension of values such as truth-telling, and honing their view of empathy.

Teaching how to deliver bad news: a systematic review

“…Regarding teaching techniques, the most valuable methods seem to be the adoption of mixed strategies because it involves different types of approaches, which is favorable in the process of making memories. It is also consistent with the results of various studies 8,21,22,[39][40][41][42][43][44][45][46][47][48][49][50][51] . Nevertheless, a direct comparison between different methods cannot offer a definitive conclusion about the subject, because they only suggest but do not definitely demonstrate the best one.…”

“…A shared point of several strategies was the presence of feedback 13,[31][32][33][34][35]39,42,47,48 , which the students thought was of great value. Moreover, there is evidence that the feedback itself is a form of learning, because it allows students to understand and reflect on their mistakes 39 .…”

“…Other mixed strategies 21,22,[42][43][44][45][46][47] including brief lectures, discussions and simulations were described as important and effective, resulting in more confidence and proficiency in breaking bad news. In Abel and collaborators 43 , there is a point emphasizing that the multi-professional group proved to be positive to palliative care and education.…”

General and professional values of student nurses and nurse educators

“…(). Communication skills and empathy were essential for a nurse to support patients through all phases of care (Hurst, Baroffio, & Burn, ).…”

Understanding the impact of simulated patients on health care learners’ communication skills: a systematic review

“…Lastly, 34 (57%) of the studies gathered information from the learners on their reaction to the use of SPs during communication training . Overall, learners reported satisfaction with training, with one study reporting that although the learners were not looking forward to it, they reported finding the process helpful .…”