title: Teaching Surgery Residents the Skills to Communicate Difficult News to Patient and Family Members: A Literature Review.
abstract: BACKGROUND
  Trainees and practicing physicians alike find breaking bad, sad, or difficult news to a patient or family member as one of the most challenging communication tasks they perform. Interpersonal and communication skills are a core competency for resident training. However, in disciplines where technical skills have a major emphasis, such as surgery, the teaching of communication skills may not be a priority.
  
  
  OBJECTIVE
  The objective of our study is to review literature in order to identify best practices and learning modalities used to teach surgery trainees the communication skills regarding delivery of difficult news to patients and family members.
  
  
  METHODS
  The criteria for inclusion in this literature review were that the study (1) addresses surgeons' training (nontechnical skills) in breaking difficult news to patient and/or families, (2) describes a teaching modality or intervention targeted to teach surgery residents how to deliver difficult news to patient/family, and (3) is published in English.
  
  
  RESULTS
  Articles (n = 225) were screened for final eligibility. After discarding duplicates and noneligible studies, and after abstract/full-text review, 18 articles were included in the final analysis. Most studies are single site; address general surgery residents at varying training levels; and include case-specific, outpatient, and intensive care unit (ICU) settings. There is a paucity of studies in the trauma and unexpected death setting. There is a recent trend to use Objective Structured Clinical Examination (OSCE) both to teach and assess communication skills. Variable tools are used to assess this competency as described.
  
  
  CONCLUSIONS
  Simulation and OSCE format have emerged as modalities of choice both to teach surgery residents how to deliver difficult news and to assess achievement of this competency. There is a gap in the literature regarding teaching and assessing surgery resident communication skills in delivering difficult news after unexpected events in the trauma and operating room settings.
authors.affiliation: 1 Department of Emergency Medicine, Rutgers New Jersey Medical School , Newark, New Jersey.
authors.forename: Sangeeta
authors.initials: S
authors.lastname: Lamba
authors.affiliation: 2 Department of Surgery, Rutgers New Jersey Medical School , Newark, New Jersey.
authors.forename: Leslie S
authors.initials: LS
authors.lastname: Tyrie
authors.affiliation: 2 Department of Surgery, Rutgers New Jersey Medical School , Newark, New Jersey.
authors.forename: Sarah
authors.initials: S
authors.lastname: Bryczkowski
authors.affiliation: 1 Department of Emergency Medicine, Rutgers New Jersey Medical School , Newark, New Jersey.
authors.forename: Roxanne
authors.initials: R
authors.lastname: Nagurka
mesh_terms: D003142:Communication; D003479:Curriculum; D004501:Education, Medical / Q000458:organization & administration*; D005190:Family / Q000523:psychology*; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D007398:Interpersonal Relations; D010817:Physician-Patient Relations; D013337:Students, Medical / Q000523:psychology*; D066231:Surgeons / Q000523:psychology*