Department of Primary and Community Care, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
Health Academy, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
Patient Educ Couns. 2018 Sep;101(9):1639-1644. doi: 10.1016/j.pec.2018.05.008. Epub 2018 May 7.
Breaking bad news (BBN) should be trained, preferably early and following a helical model with multiple sessions over time, including feedback on performance. It's unclear how medical students evaluate such an approach.
We gathered student opinions regarding a helical BBN training programme, the feedback and emotional support they received, and the applicability of the skills training immediately after BBN skills training (Q1) and after finishing their clinical clerkships (Q2).
Students find a helical curriculum useful, but this declines on follow-up. At Q2 students report less satisfaction with the amount of feedback and emotional support they received and report that the skills training was less applicable in clinical practice compared to what they reported at Q1.
A helical BBN training programme with early exposure seems to lead to a shift from students being unconsciously incompetent to consciously incompetent. Students would have appreciated more emotional support and feedback.
We recommend more feedback and emotional support after BBN during clerkships. The gap between classroom and practice can be diminished by emphasizing real life role play and clinical role models should demonstrate continuity and agreement between the skills that are taught and those that are used in clinical practice.
应进行医学坏消息告知（BBN）培训，最好采用螺旋式模型，分阶段多次进行，包括对表现的反馈。目前尚不清楚医学生对此类方法的评价如何。
我们收集了学生对螺旋式 BBN 培训计划的意见，他们所获得的反馈和情感支持，以及在完成 BBN 技能培训后立即（Q1）和完成临床实习后（Q2）应用技能培训的情况。
学生认为螺旋式课程有用，但随着时间的推移，这种看法有所下降。在 Q2 时，与 Q1 相比，学生对他们所获得的反馈和情感支持的满意度较低，并且报告说技能培训在临床实践中的适用性较差。
早期接触螺旋式 BBN 培训计划似乎会导致学生从无意识的无能转变为有意识的无能。学生可能会更需要情感支持和反馈。
我们建议在实习期间 BBN 后提供更多的反馈和情感支持。通过强调现实生活中的角色扮演，并让临床角色模型展示在课堂上教授的技能与实际临床实践中使用的技能之间的连续性和一致性，可以缩小课堂与实践之间的差距。
