Teaching Pediatrics Residents a Communication Framework for Delivering Difficult News: A Randomized Controlled Trial...

1) Improve resident skills in delivering difficult news (DDN) by educating pediatric residents using a communication framework with validity evidence, the m-SPIKES (an acronym for modified setting, perception, involvement, knowledge, empathy, and summarize/strategize) framework. 2) Determine whether small-group practice with peer role-play or Rapid cycle deliberate practice (RCDP) simulation is a more effective practice modality for improving DDN.

Institutional review board-exempt single-institution pilot randomized controlled trial involving 28 pediatric residents. Residents attended an educational intervention that consisted of a large-group didactic session to learn the m-SPIKES framework followed by randomization into either peer role-play or RCDP groups for small-group practice. The residents completed pre- and postsurveys regarding self-efficacy in DDN using a Likert scale and were evaluated for fundamental communication skills and mastery of m-SPIKES by trained faculty during a simulation with a standardized patient before and after the educational intervention. Data were analyzed using bivariate inferential statistical analysis with t tests.

After the educational intervention, residents in both cohorts were found to have significantly increased self-efficacy in DDN, fundamental communication skills, and overall mastery of the use of m-SPIKES (P ≤ .001). The 2 cohorts had similar improvements in self-efficacy (P = .223) and fundamental communication skills (P = .306); however, the peer role-play showed a significant improvement in mastery of m-SPIKES when compared to the RCDP group (P = .046).

While this educational intervention demonstrated a significant improvement in DDN skills for all residents in both the peer role-play and RCDP groups, more studies are needed to determine whether the use of RCDP is advantageous in communication education.