Breaking Bad News: Evaluating the Impact of a Multidisciplinary Training Program for Ophthalmology Residents

Abstract

 

Purpose

 

Breaking bad news (BBN) is a common occurrence in medicine, and ophthalmologists are not exempt. To the best of our knowledge, there are no formal programs to train ophthalmologists in this important task. We implemented a multidimensional training program to emphasize communication skills during difficult conversations with ophthalmology patients. The purpose of this study was to evaluate the impact of such formal training on BBN for ophthalmology residents.

 

Methods

 

Residents at the Havener Eye Institute participated in a Grand Rounds series on BBN. This included a practice session delivering a difficult diagnosis to 3 standardized (actor) patients, a lecture on the SPIKES protocol for BBN, and a panel discussion with 3 real ophthalmology patient volunteers. To assess the efficacy of this program, residents were invited to complete anonymous, voluntary, IRB-approved surveys. After Grand Rounds, residents were asked to evaluate each aspect of the program using a 5-point Likert scale. Before and after training, residents were asked to report their current confidence level with respect to 12 different aspects of the bad news encounter, each derived from the original SPIKES protocol. Responses were compared using the matched-pairs ordinal test. The impact of this training program was evaluated by the overall rating of the program and by improvements in resident confidence.

 

Results

 

Eleven ophthalmology residents completed the training. All 11 reported that they would use the SPIKES protocol in the future with ophthalmology patients. The mean Likert score for the overall program was 4.5. Most residents (67%) felt that the patient panel discussion was the most useful aspect of the program. Comparing matched surveys from before and after training, resident confidence in BBN increased significantly (P < 0.05) in 7 of the 12 measures. The most significant improvement was noted in the measure “setting realistic expectations without destroying hope” (p = 0.0095).

 

Conclusions

 

Formal training can improve resident confidence; therefore, teaching communication skills for BBN should be integrated into ophthalmology residency education. As part of this training, the SPIKES protocol may serve as a useful template. Volunteer patients, who are willing to share their personal experiences, may offer valuable wisdom and insight into the bad news encounter.

 

 

 

Keywords: 579 learning • 460 clinical (human) or epidemiologic studies: health care delivery/economics/manpower • 497 development