Evaluation of an educational strategy with simulation to communicate bad medical news to interns
DOI:
https://doi.org/10.22201/fm.30617243e.2026.6.114Keywords:
Simulación, Estudiante, Relación médico - paciente, ProfesionalismoAbstract
Background: Breaking bad news is a common task for doctors. Inadequate communication not only affects the doctor-patient relationship but can also have legal implications.
Objectives: Evaluate the effect of an educational intervention using clinical simulation on the communication of bad news by undergraduate medical interns.
Methods: Randomized clinical trial conducted in undergraduate medical interns, using a simple random sampling. The experimental group participated in a 3-session workshop, each lasting 1.5 hours, imparted by a thanatologist. The workshop included three key lectures: the importance of effectively breaking bad news, the SPIKES protocol, and reviewing reflective scenarios. The control group continued with their usual training. Students were evaluated on their adherence to the SPIKES protocol when delivering bad news, by a committee of experts through simulation. The study was approved by the ethics and research committee.
Results: The experimental group consisted of 18 undergraduate medical interns and the control group included 24. A total of 56.1% had received some form of training on delivering bad news during medical school. Additionally, 39% had delivered bad news during their internship, with an average of 3.25 times (SD 2.6). The experimental group improved their ability to communicate bad news (p <0.001), manage the patient's emotions (p <0.007), and in the following SPIKES steps 1) Setting up the interview, 3) Recognizing how much the patient wants to know, and 5) Responding to the patient's emotions (p<0.05).
Discussion: The limited training in communicating bad news during undergraduate programs highlights the need to incorporate it into curricula, highlighting the importance of empathy and the emotional challenges of physicians. Simulation is also positioned as a training and strategic tool for assessing these skills.
Conclusions: The educational intervention improved steps 1, 3, and 5 of the SPIKES protocol, enhanced the ability to effectively deliver bad medical news, and fostered greater empathy while improving their capacity to manage the emotions of both patients and their families.
References
Abdullah, M. A., Shaikh, B. T., Khan, K. R., Gill, A. K., Ahmed, S., Jadoon, M. K., Iqbal, S., & Khan, M. M. (2024). Breaking bad news: A mixed methods study reporting the need for improving communication skills among doctors in Pakistan. BMC Health Services Research, 24, 588. https://doi.org/10.1186/s12913-024-11056-2
Ahmad, A. A., Stewart, D. C., Kane, T., Soltani, A., Al-Khal, A., Sethi, A., & Shaikh, B. T. (2024). Health professionals’ views and experiences of breaking bad news in the Eastern Mediterranean Region: A scoping review. Frontiers in Medicine, 11, 1440867.
https://doi.org/10.3389/fmed.2024.1440867
Amsalem, D., Martin, A., Mosheva, M., Soul, O., Korotkin, L., Ziv, A., Gothelf, D., & Gross, R. (2021). Delivering difficult news: Simulation-enhanced training improves psychiatry residents’ clinical communication skills. Frontiers in Psychiatry, 12, 649090. https://doi.org/10.3389/fpsyt.2021.649090
Baile, W. F., Buckman, R., Lenzi, R., Glober, G., Beale, E. A., & Kudelka, A. P. (2000). SPIKESA six-step protocol for delivering bad news: Application to the patient with cancer. The Oncologist, 5(4), 302-311. https://doi.org/10.1634/theoncologist.5-4-302
Brito, F., & Darlic, V. (2020). Revisión bibliográfica sobre la entrega de malas noticias en medicina e intervenciones para mejorar esta habilidad. Confluencia, 5(2), 1-10. https://doi.org/10.52611/confluencia.num2.2020.479
Brito Guerrero, N. R., Zurita Soria, M. M., Padrón Fernández, L., & Pérez Reyes, J. E. (2024). Comunicación asertiva de malas noticias a pacientes y familiares de cuidados paliativos. Revista Qualitas, 28(28), 108-137. https://doi.org/10.55867/qual28.08
Brown, S. D., Callahan, M. J., Browning, D. M., Lebowitz, R. L., Bell, S. K., Jang, J., & Meyer, E. C. (2014). Radiology trainees’ comfort with difficult conversations and attitudes about error disclosure: Effect of a communication skills workshop. Jour-
nal of the American College of Radiology, 11(8), 781-787. https://doi.org/10.1016/j.jacr.2014.01.018
Buckman, R. (1984). Breaking bad news: Why is it still so difficult? BMJ (Clinical Research Edition), 288(6430), 1597-1599. https://doi.org/10.1136/bmj.288.6430.1597
Cerón-Apipilhuasco, A., & Loria-Castellanos, J. (2021). Comunicación de malas noticias en el entorno institucional: Modelo híbrido de SPIKES-GIBBS. Archivos de Medicina de Urgencias de México, 13(1), 17-21. https://www.imbiomed.com.mx/articulo.php?id=115224
Flores-Funes, D., Moreno-Gutiérrez, P. A., Zafra-Mora, L. E., & Monje-González, G. A. (2020). ¿Comunicamos correctamente las malas noticias en medicina? Resultados de un taller de formación basado en videos y debriefing. Educación Médica, 21(2), 121-125. https://doi.org/10.1016/j.edumed.2018.07.005
Garrido Molina, J. M. (2020). Comunicación de malas noticias en el ámbito prehospitalario. Revista Española de Comunicación en Salud, 11(1), 79-85. https://doi.org/10.20318/recs.2020.4791
Gordillo Navas, G. C., Trujillo Martínez, J. D., & Filizzola Bermúdez, J. D. (2020). Estrategia de simulación para aplicar el protocolo SPIKES en la comunicación de malas noticias. Universitas Médica, 61(3), 56-64. https://doi.org/10.11144/Javeriana.umed61-3.spik
Greenberg, L. W., Ochsenschlager, D., O’Donnell, R., Mastruserio, J., & Cohen, G. J. (1999). Communicating bad news: A pediatric department’s evaluation of a simulated intervention. Pediatrics, 103(6), 1210-1217. https://doi.org/10.1542/peds.103.6.1210
Joseph, N., Nelliyanil, M., Jindal, S., Utkarsha, Abraham, A. E., Alok, Y., Srivastava, N., & Lankeshwar, S. (2015). Perception of simulation-based learning among medical students in South India. Annals of Medical and Health Sciences Research, 5(4), 247-252. https://doi.org/10.4103/2141-9248.160186
Kotłowska, A., Przeniosło, J., Sobczak, K., Plenikowski, J., Trzciński, M., Lenkiewicz, O., & Lenkiewicz, J. (2022). Influence of personal experiences of medical students on their assessment of delivering bad news. International Journal of Environmental Research and Public Health, 19(19), 12040. https://doi.org/10.3390/ijerph191912040
Mayo, M. E., Iglesias-Souto, P. M., Martínez-López, Z., & Taboada-Ares, E. M. (2020). ¿Se sienten los estudiantes de Medicina suficientemente formados para comunicar malas noticias? Educación Médica, 21(4), 229-235. https://doi.org/10.1016/j.edumed.2020.07.007
Rosa Isquierdo, A. P., Bilek, E. S., & Bueno do Prado Guirro, U. (2021). Comunicación de malas noticias: De la educación médica a la práctica. Revista Bioética, 29, 344-353. https://doi.org/10.1590/1983-80422021292472
Thomas, C., Kurian, C., Houtmann, S., & Palmisiano, N. (2021). Efficacy of half-day workshop for internal medicine interns in educating breaking-bad-news discussions. Palliative Medicine Reports, 2(1), 132-136. https://doi.org/10.1089/pmr.2020.0097
Tranberg, M., & Brodin, E. M. (2023). Physicians’ lived experience of breaking bad news in clinical practice: Five essentials of a relational process. Qualitative Health Research, 33(14), 1349-1359. https://doi.org/10.1177/10497323231197534
Vermylen, J. H., Wood, G. J., Cohen, E. R., Barsuk, J. H., McGaghie, W. C., & Wayne, D. B. (2019). Development of a simulation-based mastery learning curriculum for breaking bad news. Journal of Pain and Symptom Management, 57(3), 682-687. https://doi.org/10.1016/j.jpainsymman.2018.11.012
Vidigal Soeiro, A. C., Souza Vasconcelos, V. C., & Cordero da Silva, J. A. (2022). Desafíos en la comunicación de malas noticias en una unidad de cuidados intensivos pediátrica. Revista Bioética, 30(1), 45-53. https://doi.org/10.1590/1983-80422022301505ES
Villegas Stellyes, C. E., Martínez Sánchez, L. M., Jaramillo Jaramillo, L. I., Restrepo Restrepo, N. A., & Serna Corredor, D. S. (2021). Percepción estudiantil sobre el modelo educativo basado en la simulación. Archivos de Medicina (Colombia), 21(2), 457-464. https://doi.org/10.30554/archmed.21.2.3971.2021
