What Skills Really Improve After a Flipped Educational Intervention to Train Medical Students and Residents to Break Bad News?

Burg, Luciana Bonnassis; Daetwyler, Christof; Filho, Getúlio Rodrigues de Oliveira; Castanhel, Flávia Del; Grosseman, Suely

doi:10.5539/jel.v8n3p35

Cited by 6 publications

(5 citation statements)

References 22 publications

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“…However, and in contrast to that study, we found that even though residents' self-confidence improved across all self-rated domains, blinded evaluators found no change on items assessing the way the residents addressed the SP's Emotions . This finding was inconsistent with other studies showing a change across all SPIKES domains ( 41 , 45 ). Three possible explanations may address this discrepancy: First, our study assessed a 2-month follow-up interval, compared to an immediate change in other studies.…”

Section: Discussioncontrasting

confidence: 99%

Delivering Difficult News: Simulation-Enhanced Training Improves Psychiatry Residents' Clinical Communication Skills

et al. 2021

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Background: Delivering difficult news to individuals diagnosed with mental health disorders and their family members can be challenging. The use of simulated patients (SP) is an effective teaching method to enhance clinical skills, particularly those around communication. We developed, implemented, and evaluated the effectiveness of an SP-based training module to improve psychiatric residents' clinical communication skills in delivering difficult news.Methods: We conducted 5-h workshops consisting of 3 components: (1) a high-fidelity simulation session with a professional actor; (2) a 30-min lecture; and (3) role-playing of 3 short scenarios, during which residents rotated taking on different roles (as psychiatrist, patient, or family member). We observed through a 1-way mirror and videotaped each resident's simulation session and followed it with personalized debriefing. Following the workshop, each resident received the full-length video of their simulated interview, together with a list of questions as a take-home assignment. Two months after the workshop, the residents were invited to a second SP-based session, during which 2 independent evaluators, each a board-certified psychiatrist with expertise in medical simulation, evaluated the participants' communication skills using a previously validated instrument. To avoid observation bias, the 2 evaluators rated the videotapes blind to the timing of the simulation (pre- vs. post-training). Participants completed self-report questionnaires on satisfaction and self-confidence, before, after, and 2 months following the workshop.Findings: Of the 28 psychiatric residents who participated in the training day, 24 (86%) completed the post-workshop evaluation. Mean communication score increased from 24.9 to 27.8 (paired t-test: 5.6, p < 0.001). The mean score for the self-confidence questionnaire, calculated on a 1 to 5 Likert scale, increased from 3.4 to 4.0 after the training day, and remained unchanged (4.2) 2 months later (p < 0.001).Conclusions: An SP-based training module proved useful in improving the objectively measured communication skills of psychiatric residents delivering difficult news. The training further enhanced participants' subjective sense of confidence in those clinical skills.

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Section: Discussioncontrasting

confidence: 99%

Delivering Difficult News: Simulation-Enhanced Training Improves Psychiatry Residents' Clinical Communication Skills

et al. 2021

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“…Breaking bad news to patients is "necessary in medical practice and requires training" in the use of relational communication (Burg, Daetwyler, de Oliveira Filho, Del Castanhel, & Grosseman, 2019).…”

Section: Be An Active Listenermentioning

confidence: 99%

A Curriculum, Instruction, and Assessment (CIA) Framework for Health Literacy Education (HLE) in Medical and Health Professions Schools

Ubbes¹,

Njoku²

2022

WJSSR

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There is increasing need to implement Health Literacy Education (HLE) as essential curriculum content in medical and health professions schools, supported by skill-based instructional strategies and authentic assessments. This paper reviews two decades of historical progress in health literacy and advances a new conceptual model to organize Curriculum, Instruction, and Assessment (CIA) themes for Health Literacy Education (HLE). Three themes are integrated into the Health Literacy Education (HLE) curriculum: 1) interprofessional communication in HLE, 2) cultural and linguistic competencies in HLE, and 3) a language typology that informs HLE. Two pedagogical themes are integrated into HLE instruction: 1) skill-based instructional strategies to improve oral communication (n = 7), and skill-based instructional strategies to improve written communication (n = 3). Skill-based instructional strategies to improve oral communication of medical and health professions students includes use of plain language, use of Teach Back or Show Me, encourage patients to ask questions, use medical interpreters and translators, be an active listener, respond with empathy when breaking bad news to patients, and use Chunks and Checks method. Skill-based instructional strategies to improve written communication of medical and health professions students includes write in plain language, evaluate written materials, and use pictures or visual aids to aid patient understanding. Two themes are integrated into HLE assessments: 1) formative assessment, and 2) summative assessment. The paper promotes the Curriculum, Instruction, and Assessment Framework for Health Literacy Education (CIA-HLE) for use by faculty in medical and health professions schools to ensure their students are well prepared to use oral and written communication with their patients as guided by selected research studies and initiatives. To further advance interprofessional collaboration and dialogue across the medical and health professions, a language typology and a knowledge typology are provided as building blocks to health literacy education.

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“…In order to prepare medical students and physicians for this task, the teaching has combined theory and practice 5 , generally based on frameworks that systematize the key steps of BN delivery [6][7][8] . Studies on the effects of interventions have included outcome measures such as the participants' subjective aspects (satisfaction, self-confidence, and comfort), 9 knowledge, performance in Objective Structured Clinical Examination (OSCE) rated by observers, standardized patients [10][11][12][13][14][15][16] and/or analogue patients, 17 as well as performance in recorded consultations with real patients in relation to the patients' distress, satisfaction with the consultation, and trust in the physician 18 . Nevertheless, the most effective way to teach and learn utilizing simulated patients in medical education is still unknown 19 .…”

Section: Introductionmentioning

confidence: 99%

Development of a new instrument to assess the quality of physicians' delivery of bad news

Burg

Filho

Castanhel

et al. 2022

Rev. bras. educ. med.

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Introduction: Most instruments to assess physicians’ delivery of bad news have been developed for patients with cancer and then adapted to other contexts. In clinical practice, some news may not be considered bad by the physicians but may have an important negative impact on the patients’ life. Yet, instruments to assess this communication across diverse clinical settings are needed. Objective: To develop, from the patients’ perspective, an instrument to assess how physicians deliver bad news in clinical practice. Method: This study was conducted using an exploratory qualitative approach by means of semi-structured, in-depth interviews with 109 patients from two referral hospitals in Brazil. Content analysis was used to generate categories, from which the initial instrument items were developed. The clarity and relevance of the items were evaluated by a committee of 11 medical professionals and 10 patients. Results: The instrument included items about the physicians’ attitudes, such as attention, respect, and sincerity, as well as items about sharing information using language that patients could understand. The initial instrument had 19 items, answered in a 5-point Likert scale with labeled endpoints. After evaluation by the committee of judges, 2 items were modified, and 3 were excluded. The final instrument thus had 16 items. Conclusion: A new 16-item instrument was developed from the patients’ perspective to assess physicians’ delivery of bad news. After additional validation, this instrument may be useful in real and diverse bad news settings in clinical practice.

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What Skills Really Improve After a Flipped Educational Intervention to Train Medical Students and Residents to Break Bad News?

Cited by 6 publications

References 22 publications

Delivering Difficult News: Simulation-Enhanced Training Improves Psychiatry Residents' Clinical Communication Skills

Delivering Difficult News: Simulation-Enhanced Training Improves Psychiatry Residents' Clinical Communication Skills

A Curriculum, Instruction, and Assessment (CIA) Framework for Health Literacy Education (HLE) in Medical and Health Professions Schools

Development of a new instrument to assess the quality of physicians' delivery of bad news

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