There is evidence supporting the efficacy of a simulation-based mastery learning (SBML) program during medical clerkships to prepare medical students for the delivery of bad news, according to study data published in Academic Medicine.

A “breaking bad news” (BBN) SBML curriculum was administered to all fourth-year students enrolled in a medical sub-internship at the Northwestern University Feinberg School of Medicine in Chicago, Illinois, between September 2017 and August 2018. Per the SBML curriculum, students participated in a 4-hour BBN skill workshop composed of instruction, focused feedback, and practice with simulated patients. Students completed pre- and post-test evaluations that evaluated BBN capacity using a standardized 15-item checklist. The post-test was conducted between 1 and 14 days after the initial workshop intervention. If a student achieved a minimum passing score on their initial post-test they graduated from the SBML curriculum. Students who failed were asked to complete a series of one-on-one workshops with faculty until the minimum passing score was achieved. Pre- and post-test evaluation scores were compared in order to assess SBML efficacy.

A total of 85 students completed a medical sub-internship during the study period, of whom 79 (93%) completed the SBML curriculum. The majority of students were men (62%) between 25 and 30 years of age (71%). The most commonly endorsed planned specialties were internal medicine (28%), emergency medicine (13%), anesthesiology (10%), and radiology (10%). The majority of students (70%) indicated that they had delivered bad news to patients before. Between the pre- and post-test evaluations, students’ performance improved from a mean checklist score of 65.0% to 94.2% correct (P <.001). In the study, 73 participants (92%) achieved a passing score at the initial post-test; among the 6 participants who did not, mastery was achieved following 45 minutes of additional practice. As a result, all 79 participants passed the BBN mastery checklist following the SBML curriculum. Nearly all individual checklist items were significantly improved following training, with the exception of 2: (1) creating initial rapport when first walking into room; and (2) delivering bad news within the first few minutes of conversation. Student surveys indicated significant improvements in self-reported confidence; the ,percentage of participants who “felt confident” delivering serious news increased from 4% to 80% (P <.001). In addition, the percentage of students who felt comfortable “navigating challenging emotions” increased from 4% to 66% (P <.001). Of the students, 76 (95%) professed enjoyment of the workshop and all said that they felt BBN was an important skill to acquire before residency.

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These data support the efficacy of an SBML curriculum and underline students’ willingness to participate in workshop-based training modules. However, given the limited sample size and single study site, researchers emphasize that the results must be extrapolated with care. “Future studies are underway to expand the SBML educational model…[and] to evaluate both long-term retention of skill[s], transfer of skills to the bedside, and effect on clinical outcomes,” investigators wrote.


Vermylen JH, Wayne DB, Cohen ER, McGaghie WC, Wood GJ. Promoting readiness for residency: embedding simulation-based mastery learning for breaking bad news into the medicine sub-internship [published online February 18, 2020]. Acad Med. doi:10.1097/ACM.0000000000003210