A recent issue of the Journal of Cancer Education reports on the experience of medical students who participated in videotaped sessions to practice conveying difficult news to “standardized patients” (SPs) by role-playing patients with different types of cancers who received bad medical news. The study was conducted to evaluate the students’ perceptions of the teaching methods used to convey bad news as well as to establish the effectiveness of the educational program developed for conveying such news.
Co-author Gwendolyn Quinn, Ph.D., director of the Survey Methods Core Facility at Moffitt declared:
“One of the biggest challenges a physician will face is conveying difficult news to a patient. Despite the importance of this skill, formal education in conveying bad news to patients has been limited.”
USF medical students are required to complete a two- to three-hour training session with three to five students, in which they learn how to communicate difficult medical news after which they have to participate in a videotaped encounter of conveying bad medical news to a standardized patient who is trained to act the part of a patient.
Co-author John V. Kiluk, M.D., F.A.C.S., an assistant member of Moffitt’s Don and Erika Wallace Comprehensive Breast Program, said:
“Many of the SPs are cancer survivors, so they have a personal connection.”
The sessions are recorded in fully equipped learning labs with bi-directional video cameras that are activated for 15 minutes after the students enter the exam rooms to record their conversation with an SP, who are instructed to focus on the emotional aspects of hearing bad news instead of asking questions with regard to treatment options.
After the recording session, the medical students gather in groups of three to five to review their videotaped sessions with a surgical oncologist, who highlights each students’ communication technique’s strengths and weaknesses and provides recommendations for improvement. One of the significant parts of these evaluations consists of the SP’s providing feedback on the students’ technique or style from their perspective.
In addition, the students also discuss their verbal and nonverbal interactions with the SPs, with an emphasis on nonverbal communication, for instance, eye contact and also their verbal skills for helping patients deal with denial, shock and tears.
The students’ follow-up questionnaire was assessed together with their discussions about their recorded encounters with the SPs. The researchers noted that students’ reported they felt an “improved comfort” in addressing difficult topics with patients.
Co-author Sophie Dessureault, M.D., Ph.D., an associate member of Moffitt’s Gastrointestinal Tumor and Immunology programs commented:
“When we analyzed the clinical experience of medical students during the Interdisciplinary Oncology Clerkship, we found that while 95 percent had witnessed the sharing of bad news during their medical education, only half the medical students had personal experience in delivering bad news. After the small group interaction, students overwhelmingly agreed that the exercise was helpful and that the SPs were ‘realistic.’ They also agreed strongly that the post-interview discussion was the most advantageous feature and that, overall, their knowledge of best practices had increased.”
The researchers highlight that students’ should remember the “art of medicine”, emphasizing that establishing a relationship with a patient and their family is often overlooked during the fast pace of clinical work.
Quinn said:
“Medical students can learn communication techniques from observing mentors. However, senior clinicians seldom have the time to role-play to help students develop skills.”
The researchers concluded that recording the conversation and subsequently evaluating the result was much better than instructor comments alone, and that the combination of video and assessor comments proved “highly beneficial.”
The authors conclude:
“Although these encounters cannot replace actual patient interactions, these exercises provide a safe learning environment for the student. As a result, the students will have a solid background from which to begin developing good communication skills in the oncology setting.”
Written by Petra Rattue