title: A failing medical educational model: a self-assessment by physicians at all levels of training of ability and comfort to deliver bad news.
abstract: OBJECTIVE
  Patient surveys consistently show physician communication remains less than ideal. While previous studies have demonstrated a lack of trainee confidence in delivering bad news, our study explores communication skills at all levels of practice and highlights potential barriers to improvement.
  
  
  METHODS
  Pediatric residents, fellows, and attendings involved in direct patient care at a major academic center participated in a voluntary questionnaire, consisting of self-assessed scales of comfort level, knowledge level, amount of training, and attitudes towards communication education. We also elicited barriers to learning and teaching as well as significant experiences.
  
  
  RESULTS
  Eligible responses (n = 253) were evenly divided between trainees and faculty. Almost half of attendings and two thirds of fellows did not feel sufficiently knowledgeable to deliver bad news. Many attendings felt disproportionately more comfortable than they felt knowledgeable. All trainees felt insufficiently knowledgeable for independent practice of this skill. Educational barriers centered on time constraints, a deemphasis, a lack of positive modeling, and minimal awareness of existing resources. Poor experiences revolved around inappropriate language and settings as well as insufficient empathy or preparedness. Positive anecdotes highlighted the importance of education and the impact of role models.
  
  
  CONCLUSIONS
  Independent of level of training, this study reveals a lack of self-assessed preparedness from many responsible for delivering bad news to patients and families. A significant barrier to improvement is the disproportionate level of self-assessed comfort versus knowledge level. Educational models should include both didactics to learn the skills and practice-based learning to refine the techniques.
authors.affiliation: Division of Hematology-Oncology, Children's Hospital Los Angeles, Los Angeles, California 90027, USA. eorgel@chla.usc.edu
authors.forename: Etan
authors.initials: E
authors.lastname: Orgel
authors.forename: Robert
authors.initials: R
authors.lastname: McCarter
authors.forename: Shana
authors.initials: S
authors.lastname: Jacobs
mesh_terms: D004501:Education, Medical; D005260:Female; D006801:Humans; D008297:Male; D017145:Models, Educational; D010166:Palliative Care; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology*; D020377:Self Efficacy; D011795:Surveys and Questionnaires; D014342:Truth Disclosure