title: Helping medical students to acquire a deeper understanding of truth-telling.
abstract: OBJECTIVE
  Truth-telling is an important component of respect for patients' self-determination, but in the context of breaking bad news, it is also a distressing and difficult task.
  
  
  METHODS
  We investigated the long-term influence of a simulated patient-based teaching intervention, integrating learning objectives in communication skills and ethics into students' attitudes and concerns regarding truth-telling. We followed two cohorts of medical students from the preclinical third year to their clinical rotations (fifth year). Open-ended responses were analysed to explore medical students' reported difficulties in breaking bad news.
  
  
  BACKGROUND
  This intervention was implemented during the last preclinical year of a problem-based medical curriculum, in collaboration between the doctor-patient communication and ethics programs.
  
  
  RESULTS
  Over time, concerns such as empathy and truthfulness shifted from a personal to a relational focus. Whereas 'truthfulness' was a concern for the content of the message, 'truth-telling' included concerns on how information was communicated and how realistically it was received. Truth-telling required empathy, adaptation to the patient, and appropriate management of emotions, both for the patient's welfare and for a realistic understanding of the situation.
  
  
  CONCLUSIONS
  Our study confirms that an intervention confronting students with a realistic situation succeeds in making them more aware of the real issues of truth-telling. Medical students deepened their reflection over time, acquiring a deeper understanding of the relational dimension of values such as truth-telling, and honing their view of empathy.
authors.affiliation: Institute for Ethics, History, and the Humanities, Geneva University Medical School, Geneva, Switzerland; Samia.hurst@unige.ch.
authors.forename: Samia A
authors.initials: SA
authors.lastname: Hurst
authors.affiliation: Unit of Development and Research in Medical Education, Geneva University Medical School, Geneva, Switzerland.
authors.forename: Anne
authors.initials: A
authors.lastname: Baroffio
authors.affiliation: Institute for Ethics, History, and the Humanities, Geneva University Medical School, Geneva, Switzerland.|CURML - University Centre of Legal Medicine, Lausanne, Switzerland.
authors.forename: Marinette
authors.initials: M
authors.lastname: Ummel
authors.affiliation: Unit of Development and Research in Medical Education, Geneva University Medical School, Geneva, Switzerland.|Nursing Department, HE-ARC, University of Applied Sciences, Neuchâtel, Switzerland.
authors.forename: Carine Layat
authors.initials: CL
authors.lastname: Burn
mesh_terms: D003142:Communication; D004504:Education, Medical, Undergraduate / Q000379:methods*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010817:Physician-Patient Relations; D013337:Students, Medical / Q000523:psychology*; D011795:Surveys and Questionnaires; D014342:Truth Disclosure; D014481:United States
keywords: clinical education; communication skills; ethics and humanities