Helping medical students to acquire a deeper understanding of truth-telling

Abstract

Problem

Truth-telling is an important component of respect for patients’ self-determination, but in the context of breaking bad news, it is also a distressing and difficult task.

Intervention

We investigated the long-term influence of a simulated patient-based teaching intervention, integrating learning objectives in communication skills and ethics into students’ attitudes and concerns regarding truth-telling. We followed two cohorts of medical students from the preclinical third year to their clinical rotations (fifth year). Open-ended responses were analysed to explore medical students’ reported difficulties in breaking bad news.

Context

This intervention was implemented during the last preclinical year of a problem-based medical curriculum, in collaboration between the doctor–patient communication and ethics programs.

Outcome

Over time, concerns such as empathy and truthfulness shifted from a personal to a relational focus. Whereas ‘truthfulness’ was a concern for the content of the message, ‘truth-telling’ included concerns on how information was communicated and how realistically it was received. Truth-telling required empathy, adaptation to the patient, and appropriate management of emotions, both for the patient's welfare and for a realistic understanding of the situation.

Lessons learned

Our study confirms that an intervention confronting students with a realistic situation succeeds in making them more aware of the real issues of truth-telling. Medical students deepened their reflection over time, acquiring a deeper understanding of the relational dimension of values such as truth-telling, and honing their view of empathy.

• clinical education
• ethics and humanities
• communication skills

Acknowledgements

We thank all the facilitators who were involved in this SP teaching intervention, all medical students who participated in the study, and the SPs for their much appreciated contribution to teaching. This research was conducted while Carine Layat Burn was an SP trainer and a research assistant at the Unit of Development and Research in Medical Education, Geneva University Medical School. Samia Hurst was supported by a grant from the Swiss National Science Foundation (PP00P3-123340).

Notes

¹We thank the anonymous reviewer for encouraging us to develop this point.