P004: ENHANCING BREAKING BAD NEWS TRAINING: A SIMULATION-BASED APPROACH FOR MEDICAL INTERNS
Dayna Hughes1; Jean-Paul Russo, MPH2; Sebastian L Zambrano2; Yvonne Diaz, MD2; Daniel Perez, MD2; Joni Maga, MD2; Danielle Horn, MD2
1Youngstown State University, Youngstown, Ohio, United States; 2Center for Patient Safety, University of Miami Miller School of Medicine and Jackson Memorial Hospital, Miami, Florida, United States
Introduction: Simulation-based medical education is essential for preparing learners to navigate the complexities of clinical practice. Delivering bad news, especially when it involves preventable medical error or unexpected adverse outcomes, is one of the most challenging communication tasks healthcare providers face. Despite its importance, structured training in breaking bad news remains limited in most medical education and residency curricula. To address this need, we developed a focused experiential educational course that allowed interns to practice delivering bad news within a structured, supportive environment guided by the setting, perception, invitation, knowledge, empathy, and summary (SPIKES) protocol with attitudes assessed via the Breaking Bad News Attitude Scale (BBNAS) before and after the intervention.
Methods: The module was integrated into the annual intern patient safety course at the Jackson Memorial Hospital Center for Patient Safety. Interns participated in a manikin-based anaphylaxis simulation caused by administration of an allergen despite documented allergy, resulting in intubation and ICU admission. Following this simulation, the interns engaged in a group debrief with a faculty member focused on medical errors, breaking bad news, and a review of the SPIKES protocol. Interns then completed the BBNAS questionnaire and two additional items self-assessing perceived comfort and confidence in delivering bad news as a baseline (pre-intervention) assessment. Next, the interns disclosed the outcome to a trained simulated family member, after which they completed the BBNAS questionnaire and the same two self-assessment items again (post-intervention assessment). Pre- and post-intervention composite scores were compared to evaluate improvement using the Wilcoxon Signed-Rank Tests.
Results: Of the 208 participating interns, complete survey data across both time points were available for more than 70% of the cohort. Mean BBNAS composite scores increased significantly from pre-intervention to post-intervention assessment (P < 0.001). BBNAS subscale scores increased in twelve out of fifteen items. Intern comfort and confidence delivering bad news also significantly increased.
Discussion: This brief, multi-level intervention produced substantial improvements in interns’ attitudes, comfort, and perceived preparedness to deliver bad news. This multi-level intervention revealed that, although didactic instruction is essential, the subsequent live encounter substantially enhanced participants’ comfort and confidence in delivering bad news. The significant improvement in BBNAS scores seen after the encounter with a simulated family member demonstrates that deliberate practice with a live actor provides additional value beyond classroom-based training. These findings support the incorporation of a realistic breaking bad news simulation into medical resident training curriculum.
References:
Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP. SPIKES-A six-step protocol for delivering bad news: application to the patient with cancer. Oncologist. 2000;5(4):302-311. doi:10.1634/theoncologist.5-4-302
Dos Santos KL, Gremigni P, Casu G, Zaia V, Montagna E. Development and validation of The Breaking Bad News Attitudes Scale. BMC Med Educ. 2021;21(1):196. Published 2021 Apr 7. doi:10.1186/s12909-021-02636-5
Elendu C, Amaechi DC, Okatta AU, et al. The impact of simulation-based training in medical education: A review. Medicine (Baltimore). 2024;103(27):e38813. doi:10.1097/MD.0000000000038813