Abstract:
Introduction: Breaking bad news to patients is one of the most common, and often
difficult, responsibilities in the practice of medicine, particularly in cancer related diagnosis.
Breaking bad news in an abrupt and insensitive manner may not only be devastating for
both the patient and his or her family but is also associated with poor treatment outcomes
and doctor burnout. This task is commonly done by residents who are on training. The
complexity of the current resident work environment, including the impact of making
money or finances in third world countries, is underappreciated. A study to establish the
effectiveness of a training intervention to assist residents in breaking bad news hit a big
snag when the training workshop, which was held on a weekend, received approximately
10 attendees. 40 attendees were expected.
Methods: A quantitative research approach, a quasi-experimental group design was
utilized. A purposeful sample of 80 physicians who are residents were selected for the
study on a first-come-first-served basis. They were then randomly grouped into two
groups: test group and control group. Test group was trained and compared with the
control group. Perceived competence in performing breaking bad news tasks by residents
was measured using two learning domains: cognitive and affective. These evaluated self–
efficacy, empathy and physician’s beliefs before and after the training. To achieve this, we
designed a flipped classroom program and, two weeks later, a workshop for the test group
was held. Cronbach’s alpha, median and interquartile range (IQR) was calculated in SPSS
version 22. P-value less than or equal to 0.05 was taken as statistically significant. Ethical
approval was obtained from the Institutional Review and Ethics Committee (IREC) of Moi
University and Moi Teaching and Referral Hospital.
Results: A post-workshop survey of residents’ self-efficacy score in breaking bad news
tasks, empathy scores using JSPE and physician belief scores were assessed. The
post-workshop survey revealed that the residents’ self-efficacy scores improved
significantly when compared with the control group. However, empathy scores and
physician belief scores did not change significantly. Resident responses also exposed some
challenges in communication skills training in real-life clinical settings for them. There was
an apparent less humanistic approach to patients by residents suggesting biomedical
curriculum based on the philosophy of science and less or limited in the ‘humanistic’ one
based on the art of medicine.
Conclusions: Innovative flipped classroom format in combination with workshop sessions
allows easy incorporation of breaking bad news skills training for residents in a
postgraduate training program.