Layat Burn Carine, Hurst Samia A, Ummel Marinette, Cerutti Bernard, Baroffio Anne
Geneva University Medical School , Switzerland.
Med Teach. 2014 Mar;36(3):251-9. doi: 10.3109/0142159X.2013.853118. Epub 2014 Feb 5.
Truth-telling is a complex task requiring multiple skills in communication, understanding, and empathy. Its application in the context of breaking bad news (BBN) is distressing and problematic if conducted with insufficient skills.
We investigated the long-term influence of a simulated patient-based teaching intervention integrating the learning of communication skills within an ethical reflection on students' ethical attitudes towards truth-telling, perceived competence and comfort in BBN.
We followed two cohorts of medical students from the preclinical third year to their clinical rotations (fifth year). We analysed their ethical attitudes and level of comfort and competence in BBN before, after the intervention, and during clinical rotations.
Students' ethical attitudes towards truth-telling remained stable. Students feeling uncomfortable or incompetent improved their level of perceived comfort or competence after the intervention, but those feeling comfortable or competent became more aware of the difficulty of the situation, and consequently decreased their level of comfort and competence.
Confronting students with a realistic situation and integrating the practice of communication skills within an ethical reflection may be effective in maintaining ethical attitudes towards truth-telling, in developing new skills and increasing awareness about the difficulty and challenges of a BBN situation.
告知真相是一项复杂的任务，需要沟通、理解和同理心等多种技能。如果在传达坏消息（BBN）时技能不足，其应用会令人痛苦且存在问题。
我们研究了一种基于模拟患者的教学干预措施的长期影响，该干预措施将沟通技能的学习融入到对学生关于告知真相的伦理态度、在传达坏消息时的感知能力和舒适度的伦理反思中。
我们追踪了两组医学生，从临床前第三年到他们的临床实习（第五年）。我们分析了他们在干预前、干预后以及临床实习期间对告知真相的伦理态度、舒适度和能力水平。
学生对告知真相的伦理态度保持稳定。在干预后，那些感到不舒服或无能力的学生提高了他们的感知舒适度或能力水平，但那些感到舒适或有能力的学生更加意识到情况的困难，因此降低了他们的舒适度和能力水平。
让学生面对现实情况，并将沟通技能的实践融入伦理反思中，可能有效地维持对告知真相的伦理态度，培养新技能，并提高对传达坏消息情况的困难和挑战的认识。
