title: Social worker assessment of bad news delivery by emergency medicine residents: a novel direct-observation milestone assessment.
abstract: The skill of delivering bad news is difficult to teach and evaluate. Residents may practice in simulated settings; however, this may not translate to confidence or competence during real experiences. We investigated the acceptability and feasibility of social workers as evaluators of residents' delivery of bad news during patient encounters, and assessed the attitudes of both groups regarding this process. From August 2013 to June 2014, emergency medicine residents completed self-assessments after delivering bad news. Social workers completed evaluations after observing these conversations. The Assessment tools were designed by modifying the global Breaking Bad News Assessment Scale. Residents and social workers completed post-study surveys. 37 evaluations were received, 20 completed by social workers and 17 resident self-evaluations. Social workers reported discussing plans with residents prior to conversations 90 % of the time (18/20, 95 % CI 64.5, 97.8). Social workers who had previously observed the resident delivering bad news reported that the resident was more skilled on subsequent encounters 90 % of the time (95 % CI 42.2, 99). Both social workers and residents felt that prior training or experience was important. First-year residents valued advice from social workers less than advice from attending physicians, whereas more experienced residents perceived advice from social workers to be equivalent with that of attending physicians (40 versus 2.9 %, p = 0.002). Social worker assessment of residents' abilities to deliver bad news is feasible and acceptable to both groups. This formalized self-assessment and evaluation process highlights the importance of social workers' involvement in delivery of bad news, and the teaching of this skill. This method may also be used as direct-observation for resident milestone assessment.
authors.affiliation: Department of Emergency Medicine, College of Medicine, The University of Arizona, P.O. Box 245057, Tucson, AZ, 85724-5057, USA. amin@aemrc.arizona.edu.
authors.forename: Alice Ann
authors.initials: AA
authors.lastname: Min
authors.affiliation: Department of Obstetrics and Gynecology, College of Medicine, The University of Arizona, Tucson, AZ, USA.|Faculty Instructional Development, Office of Medical Student Education, College of Medicine, The University of Arizona, Tucson, AZ, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Spear-Ellinwood
authors.affiliation: Department of Clinical Resource Management, University of Arizona Medical Center, Tucson, AZ, USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Berman
authors.affiliation: Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, USA.
authors.forename: Peyton
authors.initials: P
authors.lastname: Nisson
authors.affiliation: Department of Emergency Medicine, College of Medicine, The University of Arizona, P.O. Box 245057, Tucson, AZ, 85724-5057, USA.|Division of Geriatrics, General Medicine, and Palliative Medicine, College of Medicine, The University of Arizona, Tucson, AZ, USA.|Arizona Center on Aging, The University of Arizona, Tucson, AZ, USA.
authors.forename: Suzanne Michelle
authors.initials: SM
authors.lastname: Rhodes
mesh_terms: D000328:Adult; D000368:Aged; D003142:Communication; D004635:Emergency Medicine / Q000379:methods*; D005260:Female; D006801:Humans; D007396:Internship and Residency; D007400:Interprofessional Relations; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D012647:Self-Assessment; D000068217:Social Workers / Q000523:psychology*; D011795:Surveys and Questionnaires; D000078329:Workforce
keywords: Bad news delivery; Communication; Interprofessional team; Milestone assessment; Resident education; Survey