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

Author(s)

Vellutini Setubal, Maria Silvia ^[1] ; Goes Monteiro Antonio, Maria Angela Reis ^[1] ; Amaral, Eliana Martorano ^[1] ; Boulet, John ^[2]

Affiliation

^[1] Univ Estadual Campinas, Fac Ciencias Med, Alexandre Fleming St 101, BR-13083891 Campinas, SP - Brazil

^[2] Fdn Adv Int Med Educ & Res, Philadelphia, PA - USA

• Document type: Journal article
• Source: Revista Brasileira de Ginecologia e Obstetrícia; v. 40, n. 3, p. 137-146, MAR 2018.
• Web of Science Citations: 1

Abstract

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. Resumo Objetivo E uma tarefa particularmente dificil transmitir mas noticias em perinatologia. Habilidades de comunicacAo podem ser aprendidas, ensinadas e praticadas. O presente estudo avalia se uma sessAo de treinamento estruturado para comunicar mas noticias ampliaria as habilidades dos residentes de perinatologia. Metodos Estudo de intervencAo controlado e aleatorizado com residentes do 1 degrees ao 4 degrees ano do curso de perinatologia de uma faculdade de ciencias medicas no ano letivo de 2014/15. Um total de 61 dos 100 residentes elegiveis (61%) voluntariaram-se para um programa de treinamento envolvendo comunicar uma perda perinatal para uma paciente simulada no papel da mAe, seguido do feedback imediato da atriz, ambos filmados. Posteriormente, os residentes foram aleatoriamente designados para um grupo de treinamento em mas noticias baseado na estrategia SPIKES e revisAo dos videos (intervencAo) ou para um grupo-controle, sem treinamento. Todos os residentes retornaram numa segunda simulacAo analoga a primeira, com a mesma paciente simulada cega a intervencAo. Avaliou-se as habilidades dos residentes segundo um checklist preenchido pela atriz. A analise estatistica incluiu analise de covariancia para medidas repetidas (ANCOVA-MR). Os residentes avaliaram a atividade de simulacAo com feedback. Resultados O programa foi completado por 58 residentes. As simulacoes duraram em media 12 minutos, o feedback 5 minutos, e o treinamento SPIKES entre 1h e 2,5h. NAo houve diferenca significativa nas atuacoes dos residentes segundo a paciente simulada ( p =0.55). Os residentes avaliaram a simulacAo com feedback positivamente. Essas atividades podem ter reduzido o impacto do treinamento SPIKES. ConclusAo O treinamento SPIKES nAo teve impacto significativo na atuacAo dos residentes. Os residentes consideraram as simulacoes com feedback uteis. Mais pesquisas sAo necessarias para determinar qual modalidade e mais eficaz. (AU)

• FAPESP's process: 13/24185-0 - Evaluation of the efficacy of a resident's training program in delivering bad news in Perinatology using standardized patients
• Grantee: Eliana Martorano Amaral
• Support Opportunities: Regular Research Grants