- A new study is the first to show that educational training can be used in clinical training to improve how medical students approach difficult conversations.
- The study involved 79 4th-year medical students.
- Experts say having clear, compassionate conversations with patients is critically important.
Doctors don’t have an easy job.
Diagnosing conditions and treating patients can be a challenging journey, as many conditions can take unpredictable twists and turns at any given moment.
But one of the hardest parts of the job is sitting down with a patient and sharing the test results, outlook, or life expectancy no one wants to hear.
Many doctors feel they never received the proper training to handle these difficult conversations.
Consequently, medical schools around the country have recently launched training programs to coach future doctors how to approach tough topics, and ensure they’re giving patients plenty of compassion and empathy.
Northwestern University’s Feinberg School of Medicine is one such school. It recently put its training program — an innovative, simulation-based course designed to help medical students master talking with patients — to the test to determine just how effective it is.
According to the findings, which were published in the journal Academic Medicine mid-February, simulation-based training can effectively prepare doctors for real-world scenarios in which they have to deliver bad news.
The study is the first to show that educational training can be used in clinical training to improve how medical students approach difficult conversations.
“Physician communication has repeatedly been shown to impact countless outcomes, and it is time that we begin to apply educational techniques that allow us to ensure that all physicians possess key communication skills,” the study’s first author, Dr. Julia Vermylen, assistant professor of medicine and medical education at Feinberg, told Healthline.
The study involved 79 4th-year medical students who were enrolled in a medicine sub-internship (internal medicine, surgery, OB-GYN, or pediatrics) at Feinberg between 2017 and 2018.
Before the training sessions, the students had to practice what they would tell a patient if they had identified a mass in their brain that had a strong chance of being cancerous.
These sessions were recorded then evaluated by faculty who rated the interaction via a performance checklist.
The students then participated in a 4-hour interactive training session — clinically called “simulation-based mastery learning” — in which they practiced breaking bad news to trained actors.
The workshops included didactic instruction and real-time, personalized feedback from faculty.
The students then completed another test, in which they delivered bad news to another patient. This was then evaluated via the performance checklist.
The researchers found that the students’ communication skills drastically improved after the workshop.
During the pretest, the students got about 65 percent of checklist items correct. After the training session, they scored 94 percent of the checklist items correctly.
“By insisting on excellence for all, simulation-based mastery learning of communication skills ensures that every single one of these physicians can communicate clearly and compassionately and help their patients figure out what to do next when confronted with a serious medical condition,” said Dr. Gordon Wood, a study co-author and Feinberg associate professor of medicine and medical education.
Having clear, compassionate conversations with patients is critically important.
Failing to do so has been linked to medical errors, malpractice claims, and preventable deaths.
These conversations often stay with patients and their families for life and have a tremendous impact on their quality of life.
“When patients receive serious news, it is often a pivotal moment in an individual’s or family’s life. It is both a moment that can build trust between a patient and physician when handled well or instill a sense of isolation and abandonment when handled poorly,” Vermylen said.
Wood says it can also affect how patients and their families make healthcare decisions and which treatments they choose.
If the conversation goes poorly, it can rattle the doctor delivering the news as well.
“There’s also evidence that physicians who have not been trained to have these conversations well experience more burnout because of how stressful these conversations can be if you aren’t confident in your skills,” Wood said.
According to Dr. Tara Sanft, a Yale Medicine medical oncologist who’s the chief patient experience officer at the Yale Cancer Center, most doctors choose to work in medicine because they want to help people.
Interacting with patients in a compassionate, caring way is the most common procedure they do, Sanft says.
Yet many doctors received virtually no communications training in medical school.
“Historically, most of doctors’ training has focused on learning the medications and procedures used to treat disease,” Sanft said. “Very little time is spent recognizing the way we communicate as a procedure, with tangible skills that can be taught and learned.”
In recent years, however, being able to gracefully break bad news has come into focus within the medical community.
It’s now recognized as a key skill that should be required for graduating medical students.
More schools have adopted training programs to teach clinicians these skills, but the vast majority of these programs aren’t integrated into the students’ clerkships, nor do they allow students to practice the conversations until they’ve mastered the skills.
They typically have students role-play during a standard, set amount of time.
The Northwestern program ensures that each student masters these skills, no matter how long it takes each individual learner.
“I think a program like this can not only change how patients hear and process important information, I think it can lead to consistent, high quality, human connections; minimize harm done by conversations gone awry; and lead to more meaningful relationships for both the patient and the doctor,” Sanft said.
And that can help create a more patient-centered culture of medicine, she adds.
Having tough conversations with patients is one of the most emotionally challenging parts of being a doctor, yet many healthcare providers haven’t received the necessary training for these conversations.
New research shows that simulation-based training that allows students to master communication skills improves outcomes and should be an integrated part of medical schools around the country.