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Rev Bras Ginecol Obstet. 2018 Mar;40(3):137-146. doi: 10.1055/s-0037-1621741. Epub 2018 Jan 17.

Improving Perinatology Residents' Skills in Breaking Bad News: A Randomized Intervention Study.

Author information

1
Faculdade de Ciências Médicas, Universidade de Campinas, Campinas, SP, Brazil.
2
Foundation for Advancement of International Medical Education and Research, Philadelphia, PA, United States.

Abstract

in English, Portuguese

OBJECTIVE:

 Breaking bad news (BBN) is particularly difficult in perinatology. Previous research has shown that BBN skills can be learned and improved when taught and practiced. This project evaluated whether a structured training session would enhance perinatology residents' skills in BBN.

METHODS:

 This was a randomized controlled intervention study with year 1 to 4 Perinatology residents from a medical school in Brazil, during the 2014/15 school year. A total of 61 out of 100 (61%) eligible residents volunteered to a structured training program involving communicating a perinatal loss to a simulated patient (SP) portraying the mother followed by the SP's immediate feedback, both video recorded. Later, residents were randomly assigned to BBN training based on a setting, perception, invitation, knowledge, emotion and summary (SPIKES) strategy with video reviews (intervention) or no training (control group). All residents returned for a second simulation with the same SP blinded to the intervention and portraying a similar case. Residents' performances were then evaluated by the SP with a checklist. The statistical analysis included a repeated measures analysis of covariance (RM-ANCOVA). Complementarily, the residents provided their perceptions about the simulation with feedback activities.

RESULTS:

 Fifty-eight residents completed the program. The simulations lasted on average 12 minutes, feedback 5 minutes and SPIKES training between 1h and 2h30m. There was no significant difference in the residents' performances according to the SPs' evaluations (p = 0.55). The participants rated the simulation with feedback exercises highly. These educational activities might have offset SPIKES training impact.

CONCLUSION:

 The SPIKES training did not significantly impact the residents' performance. The residents endorsed the simulation with feedback as a useful training modality. Further research is needed to determine which modality is more effective.

PMID:
29342495
DOI:
10.1055/s-0037-1621741
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Conflict of interest statement

The authors declare that there are no conflicts of interest.

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