title: Breaking Bad News in obstetrics: a randomized trial of simulation followed by debriefing or lecture.
abstract: OBJECTIVE
  Although communication skills represent an increasingly important aspect of medical care, little has been done to assess the best method of teaching these skills. Our study was designed to assess simulation-debriefing compared to lecture in teaching skills for Breaking Bad News (BBN) in obstetrics.
  
  
  METHODS
  This is a randomized prospective trial of house staff from a large academic medical center. Subjects initially underwent baseline simulation, followed by evaluation on BBN skills by themselves, a faculty observer, and the standardized patient (SP). The subjects were then immediately randomized to a debriefing session by faculty or to a lecture about BBN. Subsequently, both groups underwent a second simulation with the same three assessments, yielding post-intervention data.
  
  
  RESULTS
  35 subjects completed both simulations. Both debriefing and lecture curricula showed improvement in scores by self (p = 0.010) and faculty (p < 0.001). The debriefing group improved significantly more than the lecture group for self-evaluation; additionally, improvements were greater for the debrief group in verbal and nonverbal skills. Long-term follow-up three months after both interventions demonstrated continued improvement in BBN.
  
  
  CONCLUSIONS
  Simulation training with debriefing is effective for teaching communication skills, and superior to lecture for self-perceived improvement. Long-term follow-up suggested retention of confidence in BBN skills.
authors.affiliation: a Department of Obstetrics & Gynecology and Women's Health , Montefiore Medical Center/Albert Einstein College of Medicine , Bronx , NY , USA and.
authors.forename: Chavi Eve
authors.initials: CE
authors.lastname: Karkowsky
authors.affiliation: a Department of Obstetrics & Gynecology and Women's Health , Montefiore Medical Center/Albert Einstein College of Medicine , Bronx , NY , USA and.
authors.forename: Ellen J
authors.initials: EJ
authors.lastname: Landsberger
authors.affiliation: a Department of Obstetrics & Gynecology and Women's Health , Montefiore Medical Center/Albert Einstein College of Medicine , Bronx , NY , USA and.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Bernstein
authors.affiliation: a Department of Obstetrics & Gynecology and Women's Health , Montefiore Medical Center/Albert Einstein College of Medicine , Bronx , NY , USA and.
authors.forename: Ashlesha
authors.initials: A
authors.lastname: Dayal
authors.affiliation: a Department of Obstetrics & Gynecology and Women's Health , Montefiore Medical Center/Albert Einstein College of Medicine , Bronx , NY , USA and.
authors.forename: Dena
authors.initials: D
authors.lastname: Goffman
authors.affiliation: b Department of Natural Sciences , Fordham University , New York , NY , USA.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Madden
authors.affiliation: a Department of Obstetrics & Gynecology and Women's Health , Montefiore Medical Center/Albert Einstein College of Medicine , Bronx , NY , USA and.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Chazotte
mesh_terms: D002983:Clinical Competence; D003479:Curriculum; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D008297:Male; D009518:New York; D009774:Obstetrics / Q000193:education*; D016544:Patient Simulation; D010817:Physician-Patient Relations; D011446:Prospective Studies; D014342:Truth Disclosure
keywords: Breaking Bad News; communication skills; medical education; randomized controlled study; simulation