Teaching students to break bad news

Background: Physicians typically learn to communicate bad news to patients through trial and error or observation of more senior physicians. To give medical students initial instruction and experience in this area, we developed two standardized patient instructor (SPI) experiences in “breaking bad news.” Methods: Twenty-one junior medical students had an SPI experience discussing a new diagnosis of rectal cancer or pregancy loss. These 21 students, and 17 students having neither experience, interviewed the pregnancy loss SPI on the clinical performance examination (CPE) at the end of the junior year. Results: Students who had previously had a “breaking bad news” SPI experience performed significantly better on the CPE pregnancy loss station than students without this experience. There was no significant difference in performance between students who had previously had the pregnancy loss versus rectal cancer SPI. Conclusions: This research provides evidence for the effectiveness of bad news communication skills teaching, and its potential for transfer across content areas.