title: The application of the Practitioners in Applied Practice Model during breaking bad news communication training for medical students: a case study.
abstract: OBJECTIVE
  Breaking bad news is a key skill within clinical communication and one which can impact outcomes for both the patient and practitioner. The evidence base for effective clinical communication training in breaking bad news is scarce. Frameworks have been found to assist the practitioner, such as SPIKES; however, the pedagogical approach used alongside such frameworks can vary. This study sought to examine the impact of utilising the Practitioners in Applied Practice Model (PAPM) alongside the SPIKES framework for training undergraduate medical students in breaking bad news.
  
  
  RESULTS
  A case study approach is used to highlight the impact of training based on the PAPM and SPIKES on patient-centred communication and simulated patient satisfaction with the clinical communication behaviour. Results showed that following training, both patient-centred behaviour and patient satisfaction improved. With detailed communication behaviour changes, a balance was established between rapport building behaviour, lifestyle and psychosocial talk alongside biomedical information.
  
  
  CONCLUSIONS
  This case study shows how the PAPM could be utilised alongside the SPIKES framework to improve breaking bad news communication in medical undergraduate students and describes the behavioural basis of the improvement. Further research is required to show the generalisability of this training intervention.
authors.affiliation: Undergraduate Student, The School of Medicine, University of Manchester, UK.
authors.forename: Rose
authors.initials: R
authors.lastname: Dunning
authors.affiliation: Principal Teaching Fellow, The School of Medicine, University of St Andrews, UK ahl1@st-andrews.ac.uk.
authors.forename: Anita
authors.initials: A
authors.lastname: Laidlaw
mesh_terms: D001291:Attitude of Health Personnel; D001318:Authoritarianism; D002983:Clinical Competence / Q000592:standards*; D003142:Communication; D004504:Education, Medical, Undergraduate / Q000592:standards*; D004645:Empathy; D055317:Evidence-Based Practice; D006801:Humans; D010817:Physician-Patient Relations / Q000941:ethics; D011361:Professional Competence / Q000592:standards; D024382:Professional Role / Q000523:psychology*; D012017:Referral and Consultation; D012381:Role Playing; D012606:Scotland; D013337:Students, Medical / Q000523:psychology*; D014342:Truth Disclosure / Q000941:ethics
keywords: Clinical communication training; SPIKES; patient satisfaction; patient-centred