Evaluation of communication skills among students of the final year of medical faculty Medical University of Warsaw in area of bad news transmission

Abstract

Introduction. An important element of general medical skills is the ability to deliver bad news in an effective and emotionally burdensome manner for medical personnel as doctors usually are. Preparing graduates for such a challenge is to familiarize them with the elements of the SPIKES protocol, referring to the 6 elements of the interview that should be included during the giving information.

Material and methods. The study has been conducted among the last-year students of the Faculty of Medicine, Medical University of Warsaw, participating in classes at the Medical Simulation Centre (MSC) as part of the “Specialty chosen by the student” block. As a part of that course was the participation of students in a scenario assuming the need to deliver bad news to the family of a patient who has died due to cardiac arrest. Students worked in four-person therapeutic teams, in which 1 student acted as the head of the therapeutic team, 3 other students acted as team member. A previously trained person played the role of a family member. The students’ behaviour was assessed by an independent observer based on audiovisual recordings.

Results. Out of 369 students participating in the simulation classes described above at the MSC, 148 people making up 37 Emergency Medical Team (EMT) agreed to an audiovisual recording enabling the study to be carried out. 86% of those speaking with the simulated patient playing the role of the patient’s family ensured a sufficiently long conversation time related to the needs of the family. About 2/3 of the respondents (68.5%) reflected the emotions of the interlocutor and was able to name them and reacted on an ongoing basis to the patient’s reactions in terms of the bad news delivered (63%). Less than half of the respondents (48.5%) took care to maintain intimacy during the conversation. 20% of students provided preliminary information about the incident to introduce them to the interview, and less than 10% of the respondents summed up the interview and suggested further proceedings.

Conclusions. The analysis of last year Faculty of Medicine students behaviour showed that practically all elements of the SPIKES protocol require a lot of attention and thorough discussion in the education of subsequent years of students of the medical faculty. Teaching the ability to communicate unfavourable information should take place both at the stage of undergraduate education and its completion in postgraduate education.