Breaking Bad News: A Simulation-Based Training Program for OB/GYN Residents

Delivering bad news has ethical, social, and medicolegal obligations for medical professionals. The way bad news is delivered directly affects patients' understanding and satisfaction with their medical care, with poor communication skills and emotional strain contributing to patient dissatisfaction and provider stress. Obstetrics and gynecology residents are often responsible for breaking bad news to patients, but there are few formal training programs focused on developing this skill.

We developed a simulation-based curriculum in delivering bad news for obstetrics and gynecology residents. The 3-hour curriculum consisted of a short didactic on palliative medicine, case-based standardized patient interaction, and a panel discussion with patients and health care professionals. Case topics included previable preterm prelabor rupture of membrane, surgical complication, cancer diagnosis, and intrauterine fetal demise. Participants completed a questionnaire based on the SPIKES protocol before and after training. Responses were compared pre- and posttraining to evaluate for change in participants' perceptions of their own ability to deliver bad news.

Fifteen obstetrics and gynecology residents, from PGY 1 to PGY 4, completed the pretraining questionnaire, and 13 completed the posttraining questionnaire. Posttraining surveys indicated that residents felt more prepared to deliver bad news compared to prior to training.

This pilot study demonstrates that a simulation-based curriculum on breaking bad news can improve residents' ability to deliver bad news. Additionally, this course could be adapted for other specialties, such as general surgery and internal medicine, to address this educational need.