Council on Medical Student Education in Pediatrics

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COMSEP 2010 Albuquerque Meeting

ASSESSMENT OF OUTCOMES AFTER IMPLEMENTING A STANDARDIZED PATIENT ENCOUNTER ADDRESSING GIVING "BAD NEWS"

Authors:
Mark E. Harrison, MD, Pediatrics, KUSM-W, Wichita, KS

 

Background: The ability to communicate effectively with pediatric patients and families is a core skill for physicians.  Policies on pediatric education call for students to be prepared to react to patients with empathy and sound medical judgment. One of the most important yet challenging forms of clinical communication is providing bad or unexpected news to parents. Physicians and trainees consistently report that communicating bad news is stressful and that they feel under-prepared for the task. The purpose of this study was to assess the effectiveness of a new teaching activity (didactic and standardized patient (SP) encounter) on student ability to convey unexpected news about health status. Methods: Medical students from the class of 2010 were divided into clerkships by the Office of Academic and Student Affairs. The first four clerkships received no formal instruction on giving bad news, and acted as the control group. The second set of four clerkships received teaching on communicating unexpected news to patients including didactic teaching, learning materials and an SP experience with related group discussion/tutorial. In July 2009, all students were assessed in a comprehensive clinical skills examination (CSA) that included a SP scenario assessing student ability to convey unexpected news to an adult patient. The primary outcome measure was a comparison of scores on the CSA case between intervention and control students. Data analysis included t-tests and Mann Whitney-U tests. Results: No significant difference was found between the control (N=20) and intervention groups (N=21) regarding CSA scores (U=-0.404,z=-404,p=0.687). However, when scores were compared between males and females within each group, CSA scores appeared to improve for males, although not to a level of significance (U=34.5,z=-1.45,p=0.146), while scores for females decreased significantly (U=24,z=-2.289,p=.022). Power was 0.112. Conclusions: While it appears that utilizing SP encounters to teach students how to give bad news has mixed results based on gender, post hoc power analysis indicates that significant results would be found in only 11% of studies with this small sample size. Future research should assess utilizing SP encounters with a larger sample size.