Jataí Medical School, Federal University of Goiás, Brazil.
Ribeirão Preto Medical School, University of São Paulo, Brazil.
Perm J. 2020;24. doi: 10.7812/TPP/19.157. Epub 2020 Feb 14.
Delivering bad news is a difficult task for physicians, and medical schools do not always prepare future physicians for this inevitable task.
To examine training in breaking bad news, to improve medical students' competence and confidence in dealing with this important aspect of clinical practice.
An exploratory study using a qualitative approach was done at a Brazilian public university's medical school, which receives 30 medical students per semester. Two focus groups were conducted in 2018, with 15 students per group, before and after the training. The intervention consisted of a 6-month (4 h/wk) course about breaking bad news offered to 30 third-year medical students. The communication course included the perspectives of health care professionals, patients, and their families; the SPIKES protocol and the "ABCDE" mnemonic for delivering bad news; general guidelines; and role-playing/simulation strategies to improve students' skills and reduce their personal limitations.
Results of the preintervention focus group demonstrated that only 30% of the students were aware of the importance of breaking bad news and of the existence of specific protocols to guide physicians in these situations. Findings from the postintervention focus group indicated that 90% of students understood the importance and began to apply protocols in their practice.
Breaking bad news is a challenge for undergraduate medical students. The results of our qualitative study showed that students' perceptions about their capability in delivering bad news increased significantly after regular and focused training. The knowledge, skills, and attitudes acquired strengthened the students' self-reported ability to deal with situations requiring breaking bad news.
The activities offered helped students develop communication skills. They made connections between their formal training (communication and cognitive skills) and actual clinical practice in a community-based rotation. The knowledge and skills acquired gave them tools needed to deliver bad news in their future clinical practice.
向患者传达坏消息对医生来说是一项艰巨的任务，医学院校并不总是为未来的医生做好应对这一不可避免任务的准备。
检查医学学生在打破坏消息方面的培训情况，以提高他们在处理临床实践中这一重要方面的能力和信心。
在巴西一所公立大学的医学院进行了一项探索性研究，该医学院每学期接收 30 名医学生。2018 年进行了两次焦点小组讨论，每组 15 名学生，在培训前后进行。干预措施包括为 30 名三年级医学生提供为期 6 个月（每周 4 小时）的关于打破坏消息的课程。该沟通课程包括医护人员、患者及其家属的观点；SPIKES 协议和用于传递坏消息的“ABCDE”记忆术；一般准则；以及角色扮演/模拟策略，以提高学生的技能并减少他们的个人限制。
干预前焦点小组的结果表明，只有 30%的学生意识到打破坏消息的重要性，以及存在特定的协议来指导医生在这些情况下的决策。干预后焦点小组的结果表明，90%的学生理解了其重要性，并开始在实践中应用协议。
向医学生传达坏消息是一个挑战。我们的定性研究结果表明，学生对自己传递坏消息能力的看法在经过定期和有针对性的培训后显著提高。获得的知识、技能和态度增强了学生自我报告处理需要传达坏消息的情况的能力。
提供的活动帮助学生发展沟通技巧。他们将正式培训（沟通和认知技能）与社区轮转中的实际临床实践联系起来。所获得的知识和技能为他们在未来的临床实践中提供了传达坏消息所需的工具。
