title: Simulated parents: developing paediatric trainees' skills in giving bad news.
abstract: OBJECTIVE
  In curriculum documents for medicine in undergraduate, post-graduate and continuing professional development, there is now a focus on communication skills. The challenges are to place communication skills in the crowded curriculum and then to construct and sustain a programme that uses an evidence-based approach to the teaching and learning of communication skills. For 6 years, we have conducted a programme that involves simulated parents supporting junior medical staff to refine their skills in communication, particularly in giving parents bad news. The aim of our study was to obtain a better understanding of the trainees' experiences of the programme.
  
  
  METHODS
  Nine junior residents individually worked through two scenarios and received feedback from the simulated parent. They gave bad news to a simulated parent/actor who then gave feedback. A recording of the simulation was provided for discussion with a designated colleague at an arranged time. The tapes were then separately appraised by two independent raters - another actor and a paediatrician. Brief written reports and conducted semi-structured interviews provided more insights into the trainees' experience of the simulation. Other participating medical/medical education staff were interviewed about the simulation programme.
  
  
  RESULTS
  Five themes emerged from the qualitative data: timeliness, emotional safety, the complexity of communication, practical usefulness and the challenge of effecting change. In addition, the ratings of the videos helped to clarify those 'parent-centred' communication skills that trainees may neglect in difficult conversations: 'ask about support', 'encourage the parent to ask questions' and 'repeat key messages'.
  
  
  CONCLUSIONS
  The evaluation highlighted the value of an early-career experiential programme to highlight the importance of communication skills in post-graduate paediatrics practice.
authors.affiliation: The University of Melbourne, Melbourne, Victoria, Australia. Jenny.gough@rch.org.au
authors.forename: Jenny K
authors.initials: JK
authors.lastname: Gough
authors.forename: Alexis R
authors.initials: AR
authors.lastname: Frydenberg
authors.forename: Susan K
authors.initials: SK
authors.lastname: Donath
authors.forename: Michael M
authors.initials: MM
authors.lastname: Marks