BAD NEWS BETTER: LEARNING BREAKING BAD NEWS DURING THE TIME OF A PANDEMIC

Abstract

The COVID-19 pandemic has changed the medical education landscape. Medical educators have been faced with unique challenges in providing medical students with authentic learning experiences under unprecedented circumstances. A three-hour educational intervention (The Bad News Better workshop) for the Arabian Gulf University senior medical students in the Kingdom of Bahrain, was developed according to Kern’s six steps of curricular development for medical education. Grounded in Kolb’s experiential cycle of learning as an educational framework, the Bad News Better Workshop included an interactive introduction of the validated (SPIKES) protocol3 for breaking bad news (BBN) role-play exercises, feedback, reflections, and discussions, and objective structured clinical examinations with trained standardized patients. We hypothesized that our intervention would promote students’ confidence and skill in breaking bad news and provide them with a positive and effective learning experience. The purpose of this mixed-methods sequential explanatory study was to identify the impact of our educational intervention on senior medical students’ learning how to break pandemic related bad news to patients and families remotely and to evaluate their learning experience and emotional activation to the intervention. Learner characteristics, previous experiences, and self-perceived confidence pre/post-course were collected. In addition, we collected pre/post self-reported and standardized patient assessments of BBN skills and post-course survey evaluations, and in-depth semi-structured interviews to measure learner learning experience and emotional activation. Thirty-two medical students participated in the workshop. Both learners’ self-reported confidence levels in BBN to patients and standardized patient assessment of skills in BBN to patients improved significantly (p.001) after participation in the workshop. Self-assessment of BBN skills improved significantly in all but one aspect, “the use of medical jargon” (p.001 and p=0.243 receptivity) and learner ratings of the workshop were very high for all items. Through qualitative analysis, we identified a series of themes associated with the learning experiences and related emotions that substantially impacted how the participants learned how to BBN during the workshop. This reflective, simulation-based workshop successfully improved medical students’ confidence and skills in BBN to patients and provided insight into practices that can help learners participate effectively in remote simulation-based learning interventions to teach communication skills such as BBN.