Promoting Readiness for Residency: Embedding Simulation-Based Mastery Learning for Breaking Bad News Into the Medicine Subinternship

Abstract

Purpose It is challenging to add rigorous, competency-based communication skills training to existing clerkship structures. The authors embedded a simulation-based mastery learning (SBML) curriculum into a medicine subinternship to demonstrate feasibility and determine the impact on the foundational skill of breaking bad news (BBN). Method All fourth-year students enrolled in a medicine subinternship at Northwestern University Feinberg School of Medicine from September 2017 through August 2018 were expected to complete a BBN SBML curriculum. First, students completed a pretest with a standardized patient using a previously developed BBN assessment tool. Learners then participated in a 4-hour BBN skills workshop with didactic instruction, focused feedback, and deliberate practice with simulated patients. Students were required to meet or exceed a predetermined minimum passing standard (MPS) at posttest. The authors compared pretest and posttest scores to evaluate the effect of the intervention. Participant demographic characteristics and course evaluations were also collected. Results Eighty-five students were eligible for the study, and 79 (93%) completed all components. Although 55/79 (70%) reported having personally delivered serious news to actual patients, baseline performance was poor. Students’ overall checklist performance significantly improved from a mean of 65.0% (SD = 16.2%) items correct to 94.2% (SD = 5.9%; P < .001) correct. There was also statistically significant improvement in scaled items assessing quality of communication, and all students achieved the MPS at mastery posttest. All students stated they would recommend the workshop to colleagues. Conclusions It is feasible to embed SBML into a required clerkship. In the context of this study, rigorous SBML resulted in uniformly high levels of skill acquisition, documented competency, and was positively received by learners.

Future doctors’ priorities and approach to breaking bad news

“…W niniejszym badaniu również zaobserwowano istotnie korzystny wpływ kursu Areopag Etyczny na zmianę postawy studentów medycyny wobec różnych kwestii i emocji związanych z przekazywaniem złych informacji. W kursach na temat komunikacji wykorzystywane są różne techniki wirtualnej symulacji [33][34][35][36]. Areopag Etyczny posługuje się wykładami dotyczącymi komunikacji, aspektów psychologicznych rozmowy, etyki w medycynie, prawa medycznego oraz rozważaniami na temat chorowania i śmierci.…”

Genetic simulation for high‐stakes conversations

“…BBN and de‐escalation techniques are currently being introduced into clerkship by several training programmes as a simulation‐based mastery learning (SBML) curriculum. SBML is a rigorous form of competency‐based education where learners engage in standardised deliberate practice on a simulator with individualised feedback until they can meet a minimum passing standard 4,6 . Findings suggest health professions education conducted using SBML methodology can improve patient care processes and outcomes 7,8…”

“…SBML methodology provides the perfect platform for learners to practice BBN in a safe nonjudgmental environment 6,9 . However, its use in Medical Genetics training is limited based on a review of the current literature 10 .…”

Video‐mediated breaking bad news simulation

“…BBN training is typically conducted through didactic instruction and simulation scenarios where medical students practice delivering difficult news in‐person to trained standardised patients. These in‐person simulations have been shown to improve learner competency in BBN and are positively received 2 ; however, little work has been done to evaluate the effectiveness of BBN training conducted through virtual mediums, such as video conferencing.…”

“…On the day of the session, all participants met in a main video‐chat room to discuss the rationale for telehealth practice and review the SPIKES and NURSE models 2,3 . Each student was then paired with an SFM in a virtual breakout room to start a 10‐minute encounter, where the student played the role of the physician delivering the new diagnosis to the SFM, followed by 5 minutes of feedback and reflection.…”