Video‐mediated breaking bad news simulation

Abstract

Background Communication between clinicians, patients, and families is a core component of medical care that requires deliberate practice and feedback to improve. In March 2020, the COVID‐19 pandemic caused a sudden transformation in communication practices because of new physical distancing requirements, necessitating physicians to communicate bad news via telephone and video‐mediated communication (VMC). This study investigated students’ experience with a simulation‐based communications training for having difficult conversations using VMC. Methods Thirty‐eight fourth‐year medical students preparing for their surgical residency participated in a simulated scenario where students discussed a new COVID‐19 diagnosis with a standardised family member (SFM) of a sick patient via VMC. Learners were introduced to an established communications model (SPIKES) by an educational video. After the simulation, SFM and course facilitators guided a debrief and provided feedback. Learners completed surveys evaluating reactions to the training, preparedness to deliver bad news, and attitudes about telehealth. Results Twenty‐three students completed evaluation surveys (response rate=61%). Few students had prior formal training (17%) or experience communicating bad news using telehealth (13%). Most respondents rated the session beneficial (96%) and felt they could express empathy using the VMC format (83%). However, only 57% felt ready to deliver bad news independently after the training and 52% reported it was more difficult to communicate without physical presence. Comments highlighted the need for additional practice. Conclusion This pilot study demonstrated the value and feasibility of teaching medical students to break bad news using VMC as well as demonstrating the need for additional training.

From chaos to creativity: Designing collaborative communication training for the delivery of bad news

“…In our previous work, we learned that a single case scenario was not enough for learners to practice and integrate these skills and that a larger number and more varied cases would be helpful. 14 , 15 We also observed that real-time critique from the SPs was highly valued and that learners expressed the desire for even more comprehensive feedback.…”

“…Although this study represented an advance from our initial single-institution studies, we remained on the “can it work?” stage of the continuum described by Bowen. 14 , 15 , 21 We hypothesized that a comprehensive, multi-institutional virtual training curriculum for communicating difficult information would be feasible and would lead to provider confidence, competence, and self-reflection.…”

Prognostication and shared decision making in neurocritical care

“…A multicenter study in the general ICU population showed substantial variability in how physicians disclose prognosis to families,81 and the same findings have recently been validated in physician-family discussions in neuroICU patients 41. Some medical schools have attempted to increase the level of education in “difficult conversations” to train physicians in how to communicate with families3536; however, these communication skills appear to deteriorate as physicians progress through their medical education and residency,82 so that the long term value of such communication training is currently uncertain.…”

“…Second, the absence of standardized evidence based clinical guidelines on how to prognosticate allows some potential “wiggle room” for clinicians in interpreting existing data 1430. Third, clinicians are not consistently trained in how to derive or communicate prognosis to families, with few receiving training in medical school 3536. More commonly still, clinicians learn via an “apprenticeship,” observing senior clinicians in their training, or develop their own prognostication strategies 37.…”

Naturalness of Face-to-Face Medium and Video-Mediated Online Communication: Doubts About Evolutionary Mismatch

“…An adaptive approach to improving VMOC is expressed in recommendations for learning users certain rules of interaction through video-mediated online platforms (gaze direction, camera and microphone mute, voice volume, “hide self” view, using an external webcam, virtual proxemics rules, interactions to enhance the sense of group belongingness, and so forth; e.g., Bailenson, 2021 ; Bennett et al, 2021 ) and training in the use of VMOC systems (e.g., Rivet et al, 2021 ) to enable users to perform their social functions in a similar way to how it is done using a face-to-face medium. In addition, this approach postulates the possibility of achieving an optimum in social interactivity mediated by new technologies through self-organization (e.g., Paradisi et al, 2021 ).…”