Enhancing compassionate communication: comparing lecture and simulation training in breaking bad news training

BACKGROUND: Delivering bad news is a fundamental communication skill in clinical practice, with direct implications for patient satisfaction, adherence, and clinical outcomes. While lecture-based teaching builds essential theoretical knowledge, simulation-based training is increasingly valued for its potential to enhance practical communication skills, including empathy, confidence, and responsiveness to patient emotions. This study explores differences in self-reported outcomes following two instructional approaches delivered at different stages of undergraduate medical training. METHODS: A quasi-experimental pre-test/post-test study was conducted at the University of Jordan with 267 medical students. Participants included 129 fifth-year students who received a lecture-based session and 138 sixth-year students who participated in simulation-based role-play. Academic year was inherently linked to instructional approach. All students completed structured self-administered questionnaires before and after the sessions assessing perceived knowledge, self-rated competence, comfort, and emotional communication domains. Paired-sample and independent-sample t-tests were used to examine within-group changes and exploratory between-group differences. RESULTS: Both groups demonstrated statistically significant improvements in self-reported knowledge, competence, and comfort with BBN delivery (p < 0.001). The simulation group reported greater perceived gains in empathy (p = 0.042), recognition of emotional reactions (p = 0.005), and confidence in responding to emotional cues during difficult conversations (p < 0.001). Simulation participants also reported higher satisfaction and were more likely to recommend the training to peers. CONCLUSIONS: Both lecture-based and simulation-based approaches were associated with improvements in students’ self-reported knowledge and comfort in delivering bad news. Simulation-based training was associated with higher perceived gains in emotional and interpersonal communication domains. These findings suggest that experiential approaches such as role-play may enhance perceived readiness in emotionally complex clinical communication.