Supiot Stéphane, Bonnaud-Antignac Angélique
Department of Human and Social Sciences, Medical Faculty of Nantes, Nantes, France.
J Cancer Educ. 2008;23(2):102-7. doi: 10.1080/08858190701849437.
Disclosing cancer is a difficult task for junior doctors.
We conducted a survey of 4th-year (of 6 years) medical students' (N = 50) expectations of training in breaking bad news and then designed a course for students in their 5th-year oncology clerkship. The course comprised (a) a group discussion that taught a 6-point protocol for delivering a diagnosis (N = 40), (b) a videotaped simulated interview with actors to assess protocol implementation and communication skills (N = 18), and (c) feedback from a senior physician. The impact of the course was assessed during the end-of-year faculty examination (N = 55).
Most students considered breaking bad news most difficult for the diagnosis of cancer or neurodegenerative disease and desired appropriate training. Their primary concerns were attitude and choice of words. During the interview, their greatest difficulty was asking patients what they want to know. In the end-of-year examination, students who took part in both the group discussion and a simulated interview did significantly better in remembering items of the 6-point protocol than those who had only taken part in the group discussion.
This pilot study shows that our course improves students' knowledge in breaking bad news such as cancer. However, its effectiveness after graduation still needs to be determined. Assessing knowledge is feasible using interviews with simulated patients in France.
对初级医生来说，透露癌症病情是一项艰巨的任务。
我们对6年制医学专业四年级学生（共50名）关于告知坏消息的培训期望进行了调查，然后为五年级肿瘤学实习学生设计了一门课程。该课程包括：（a）小组讨论，教授一个6点诊断告知方案（共40名学生参与）；（b）与演员进行录像模拟访谈，以评估方案实施情况和沟通技巧（共18名学生参与）；（c）来自一名资深医生的反馈。在年终教师考核期间对该课程的效果进行了评估（共55名学生参与）。
大多数学生认为在诊断癌症或神经退行性疾病时告知坏消息最为困难，并希望得到适当的培训。他们主要关心的是态度和措辞。在访谈中，他们最大的困难是询问患者想了解什么。在年终考核中，同时参加小组讨论和模拟访谈的学生在记住6点方案的内容方面比只参加小组讨论的学生表现明显更好。
这项初步研究表明，我们的课程提高了学生在告知癌症等坏消息方面的知识。然而，其毕业后的效果仍有待确定。在法国，通过与模拟患者进行访谈来评估知识是可行的。
