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Teaching residents how to break bad news: piloting a resident-led curriculum and feedback task force as a proof-of-concept study
  1. Joseph Sleiman1,
  2. David J Savage1,2,
  3. Benjamin Switzer1,3,
  4. Colleen Y Colbert4,5,
  5. Cory Chevalier5,6,
  6. Kathleen Neuendorf5,6,
  7. David Harris5,6
  1. 1 Internal Medicine Residency Program, Cleveland Clinic, Cleveland, Ohio, USA
  2. 2 Department of Medicine, University of California San Diego Health System, San Diego, California, USA
  3. 3 Hematology/Oncology Fellowship Program, University at Buffalo, Buffalo, New York, USA
  4. 4 Center for Educational Resources, Education Institute, Cleveland Clinic, Cleveland, Ohio, USA
  5. 5 Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
  6. 6 Department of Palliative Medicine and Supportive Care, Cleveland Clinic, Cleveland, Ohio, USA
  1. Correspondence to Dr Joseph Sleiman, Internal Medicine Residency Program, Cleveland Clinic, Cleveland, OH 44195, USA; joseph.sleiman.22{at}gmail.com

Abstract

Background Breaking bad news (BBN) is a critically important skill set for residents. Limited formal supervision and unpredictable timing of bad news delivery serve as barriers to the exchange of meaningful feedback.

Purpose of study The goal of this educational innovation was to improve internal medicine residents’ communication skills during challenging BBN encounters. A formal BBN training programme and innovative on-demand task force were part of this two-phase project.

Study design Internal medicine residents at a large academic medical centre participated in an interactive workshop focused on BBN. Workshop survey results served as a needs assessment for the development of a novel resident-led BBN task force. The task force was created to provide observations at the bedside and feedback after BBN encounters. Training of task force members incorporated video triggers and a feedback checklist. Inter-rater reliability was analysed prior to field testing, which provided data on real-world implementation challenges.

Results 148 residents were trained during the 2-hour communications skills workshop. Based on survey results, 73% (108 of 148) of the residents indicated enhanced confidence in BBN after participation. Field testing of the task force on a hospital ward revealed potential workflow barriers for residents requesting observations and prompted troubleshooting. Solutions were implemented based on field testing results.

Conclusions A trainee-led BBN task force and communication skills workshop is offered as an innovative model for improving residents’ interpersonal and communication skills in BBN. We believe the model is both sustainable and reproducible. Lessons learnt are offered to aid in implementation in other settings.

  • competency-based
  • education
  • medical
  • post-graduate
  • feedback
  • communication skills
  • resident training

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. A summary of all data for this project was included with our submission. We are happy to share the raw data for the didactic courses with any interested party.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. A summary of all data for this project was included with our submission. We are happy to share the raw data for the didactic courses with any interested party.

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Footnotes

  • Twitter @JosephHabibi_MD, @DocDavidSavage, @BenSwitzerDO, @CoryChevalier, @KtNeuendorf, @DaveHarrisMD

  • Presented at Poster presented at ACGME Back to Bedside Consortium Meeting, Chicago, Illinois, USA, August 2019 (J Sleiman, DJ Savage, B Switzer, C Chevalier and D Harris, Improving Residents’ Skills for Leading Bad News Conversations with Patients at the Bedside); ACGME Back to Bedside Consortium Meeting, October 2020 (virtual conference) (J Sleiman, DJ Savage, B Switzer, C Chevalier and D Harris, The BBN Task Force: A Trainee-Led Communication Skills Training Program for Teaching Breaking Bad News); AMA GME Innovations Summit, October 2020 (virtual conference) (DJ Savage, J Sleiman, B Switzer, C Chevalier and D Harris, The BBN Task Force: A Trainee-Led Communication Skills Training Program for Teaching Breaking Bad News).

  • Contributors JS, DJS and DH conceived of the project, wrote the grant proposal, wrote the IRB, implemented the project, oversaw data collection, wrote the initial manuscript and revised the manuscript. CYC contributed to IRB, aided in data analysis and revised the manuscript. BS, KN and CC contributed to grant proposal, assisted with project implementation and revised the manuscript.

  • Funding This study was supported by the Accreditation Council for Graduate Medical Education (ACGME) (Back to Bedside Grant 2019-2021).

  • Disclaimer The content reflects the views of the authors who are the grant recipients and does not purport to reflect the views of the ACGME or any member of the Back to Bedside Initiative.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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