Teaching medical students to give bad news: Does formal instruction help?

Background. In 1994, the Oregon Health Sciences University instituted an integrated course (Principles of Clinical Medicine; PCM) of classroom and outpatient clinic experience designed to give first- and second-year medical students a head start in clinical skills. During their third year, the students have been periodically evaluated by objective structured clinical examinations (OSCEs). Part of the OSCE assesses the student's skills in giving bad news by means of role playing. Assessment criteria fall into those measuring knowledge and those evaluating humanistic skills. Methods. To evaluate whether formal instruction in giving bad news leads to an improvement in a medical student's skills, the bad-news portions of the OSCE scores of third-year medical students taught by the old curriculum (OC) were compared with those of third-year students who had taken PCM. Results. While bad news knowledge scores did not differ significantly between the two groups of students, the average bad-news humanistic score was significantly better for the PCM group (85% vs 79%; p = 0.05). There was no significant difference in average scores for either knowledge or humanistic skills between male and female students in the PCM group. The benefit of PCM regarding delivering bad news was also reflected by a survey of attending physicians who had taught students under both the old and the new curricula. The majority of those surveyed scored students' skills in related areas better after PCM. Conclusion. Formal instruction in the first two years of medical school improved students' humanistic skills as they relate to the delivery of bad news.