Teaching and training in breaking bad news at the Dutch medical schools: A comparison

Abstract

Background: Physicians consider breaking bad news (BBN) a difficult task, and training is therefore necessary. There is much variety in what schools consider to be best practice and best timing for such training. This article discusses BBN-programmes at the Dutch medical schools. We studied how students value their training and offer recommendations.

Methods: We developed two questionnaires to obtain programme information from course co-ordinators and student opinions about BBN-training. We compared student opinions right after BBN-training (T1) and towards the end of the medical curriculum (T2).

Results: BBN-programmes in Dutch medical schools vary in timing, models used and training methods. Overall, students are satisfied with the timing. They appreciate feedback by physicians and simulated patients most. At T2, some groups of students reported that BBN-training had given them slightly less guidance than was reported by T1-students at the same institution.

Discussion: T2-students perhaps realised they had not received the amount of support they needed and may have shifted from being unconsciously incompetent to being consciously incompetent.

Recommendations: We recommend: (a) longitudinal programmes with experiential skills-training sessions and clinical practice, (b) to involve simulated patients, physicians and psychologists in training programmes as well as practising physicians who supervise students during clinical work and (c) to ensure ongoing support and feedback in the clinical phase.

Acknowledgements

We thank the following members of the NVMO Special Interest Group on Teaching of Medical Communication Skills for their help with the questionnaires, and for their feedback and suggestions: Ellen Bazelmans, José van de Kreeke, Marcel Fabriek, Sandra van Dijk, Valerie van den Eertwegh, Frank van Es and Harry Stuger. We also thank Hans Bor for his statistical advice, Siem Meijerink and Floor Kuijs who helped in gathering the data and entering these into SPSS, and all students who filled out the questionnaires.

Funding/Support

This study was supported by the Radboud University Nijmegen Medical Centre

Other disclosures: None

Ethical approval

The study was conducted with permission of the NVMO Ethical Review Board.

Disclaimers

The views expressed are those of the authors.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.