Assessment of a Novel Curriculum to Teach Bad News Delivery in the Emergency Department

Abstract

Purpose: Breaking bad news (BBN) is difficult in the ED given time constraints and lack of prior relationships. Current research on BBN teaching is primarily outside of the ED. EM residents are often tasked with this responsibility. We hypothesized that a brief structured curriculum of the novel IDEALS method of bad news delivery would increase bad news delivery comfort and skill. Methods: This was a blinded single-site prospective randomized trial conducted at an urban tertiary care hospital with a three-year EM residency. All 39 EM residents were eligible for the study and randomized to either the BBN curriculum group or control group. The BBN curriculum group was taught the IDEALS method for BBN through a didactic presentation and small group role playing exercise. Residents from both groups volunteered for pre-intervention and post-intervention assessments consisting of a survey and a two-part simulation where they inform a standardized patient of a new critical illness and subsequently disclose the patient’s death in a second interaction. Videos were evaluated by three independent graders trained by the study team using a modification of a validated tool for teaching death disclosures. Results: Eighteen of 39 residents (46%) completed the survey component of the project. Of these, 17 completed both the survey and video components, with two excluded due to video malfunction. Self-reported comfort (p < 0.01) and self-reported skill (p = 0.02) were increased significantly in participating residents who received the intervention. There was no significant difference in video scores between the intervention and the control arms. Conclusions: The novel IDEALS method of bad news delivery increases self-reported comfort and skill. There was no statistical difference in video scores between the intervention and control arms. The study was limited by size and power. A larger sample population is needed for further assessment of the IDEALS curriculum.