How me Made breaking bad news skills training workshop relevant to twenty-first century residents at Moi university school of medicine

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.