title: Teaching and training in breaking bad news at the Dutch medical schools: a comparison.
abstract: BACKGROUND
  Physicians consider breaking bad news (BBN) a difficult task, and training is therefore necessary. There is much variety in what schools consider to be best practice and best timing for such training. This article discusses BBN-programmes at the Dutch medical schools. We studied how students value their training and offer recommendations.
  
  
  METHODS
  We developed two questionnaires to obtain programme information from course co-ordinators and student opinions about BBN-training. We compared student opinions right after BBN-training (T1) and towards the end of the medical curriculum (T2).
  
  
  RESULTS
  BBN-programmes in Dutch medical schools vary in timing, models used and training methods. Overall, students are satisfied with the timing. They appreciate feedback by physicians and simulated patients most. At T2, some groups of students reported that BBN-training had given them slightly less guidance than was reported by T1-students at the same institution.
  
  
  CONCLUSIONS
  T2-students perhaps realised they had not received the amount of support they needed and may have shifted from being unconsciously incompetent to being consciously incompetent.
  
  
  CONCLUSIONS
  We recommend: (a) longitudinal programmes with experiential skills-training sessions and clinical practice, (b) to involve simulated patients, physicians and psychologists in training programmes as well as practising physicians who supervise students during clinical work and (c) to ensure ongoing support and feedback in the clinical phase.
authors.affiliation: Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, The Netherlands. e.vanweel-baumgarten@elg.umcn.nl
authors.forename: E M
authors.initials: EM
authors.lastname: van Weel-Baumgarten
authors.forename: M
authors.initials: M
authors.lastname: Brouwers
authors.forename: F
authors.initials: F
authors.lastname: Grosfeld
authors.forename: F
authors.initials: F
authors.lastname: Jongen Hermus
authors.forename: J
authors.initials: J
authors.lastname: Van Dalen
authors.forename: B
authors.initials: B
authors.lastname: Bonke
mesh_terms: D000223:Adaptation, Psychological; D002982:Clinical Clerkship; D002983:Clinical Competence; D015331:Cohort Studies; D003142:Communication; D003479:Curriculum; D004504:Education, Medical, Undergraduate; D006801:Humans; D009426:Netherlands; D016544:Patient Simulation; D010817:Physician-Patient Relations; D012189:Retrospective Studies; D013337:Students, Medical / Q000523:psychology*; D011795:Surveys and Questionnaires; D014342:Truth Disclosure