ommunication skills training has not been
formally included in the postgraduate curriculum, even though the MCI
has recognized its importance in undergraduate medical education [1].
Resident doctors generally have poor communication skills although they
face daily challenges dealing with angry or dissatisfied relatives [2].
Breaking bad news is a key determinant of psychological well- being,
especially when dealing with chronic illnesses [3]. There has been some
progress with the introduction of the ATCOM module, but the reliance on
‘role models’ and the ‘hidden curriculum’ have been the norm [4,5].
The aim of the present study was to assess the
perceptions and practice of final year pediatric residents with regard
to breaking bad news. Participants were administered a structured
questionnaire after checking for content validity, on their perceptions
and practice with special reference to breaking bad news based on the
SPIKES protocol [6].
There were 92 final year participating residents (48
boys); 49 (54%) were from Kerala, 16 (18%) from Karnataka, 14 (15%) from
Tamil Nadu, 2 (2%) from Chandigarh and 1 (1%) each from West Bengal,
Andhra Pradesh and Odisha. Pediatric residents from government medical
colleges and private medical colleges constituted 30 (33%) and 22 (24%),
respectively. There were 38 (42%) residents from private teaching
institutions and 1(1%) from government teaching hospitals. They included
18 (20%) DCH students, 47 (51%) DNB students and 27 (29%) MD students.
Only 15 (16%) residents had received any training in
communication skills. Only 32 (35%) residents were comfortable while
breaking bad news (Table I).
TABLE I Affirmative Response to Questions on Breaking Bad News by the Residents (N=92)
|
Question |
No.
(%) |
| Are you
comfortable in breaking bad news to parents?
|
32 (35) |
| Do you try to
ensure privacy in breaking the bad news?
|
83 (90) |
| Do you
introduce yourself first? |
60 (65) |
| Do you give
information in small fractions rather than
|
53 (58) |
| all at
once? |
|
| Do you check
how much the parents already know |
57 (62)
|
| before
you start? |
|
| Do you check
parent’s understanding periodically ? |
59 (64) |
| Do you
encourage to voice the concern of parents? |
66 (72) |
| Do you
tolerate periods of silence during the interview? |
60 (65) |
| Do you look
for non-verbal cues during the interview |
56 (61) |
| Do you
respond to the parent’s feelings during the |
77 (84)
|
|
interview? |
|
| Do you
summarize before ending the interview?
|
52 (57) |
Breaking bad news to parents, who often are not
prepared for it, alters their perceptions of the future of their
children suddenly and often irrevocably, with well described
consequences for the recipients as well as the doctors [3]. The present
study emphasizes that a huge lacuna exists in training of pediatric
residents, who generally have no exposure to any formal training in
communication skills [2].
Almost two-thirds reported feeling uncomfortable
while breaking bad news, and were not familiar with the structure and
components of the complex procedure. In a previous study we have found
that the communication skills of pediatric residents need improvement
[7]. Ascertaining the prior level of understanding of the parents,
giving the unpleasant news in small fractions’ and periodic checking for
comprehension are essential steps to be followed in the process of
breaking bad news [6].
There are reports that communication skills can be
improved with short training workshops [8]. Research has shown that
communication skills, generally do not improve after residency [9]. Our
findings support the need for incorporation of structured communication
skills training with emphasis on difficult issues like breaking bad
news, in the Postgraduate curriculum.
Contributors: MGG: designed the study and
collected the data; PK: analyzed the data and helped in writing the
paper.
Funding: None; Competing interest: None
stated.
References
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