Videotaped simulated interviews to improve medical students' skills in disclosing a diagnosis of cancer.

摘要

OBJECTIVE: To assess the performance of the training course on the disclosure of a diagnosis of cancer intended for fifth year medical students of the University of Nantes. METHODS: The course comprised three sessions: (1) a group discussion that taught a six-point protocol (SPIKES) for delivering a diagnosis, (2) a videotaped simulated interview to assess protocol implementation and communication skills, and (3) feedback from a senior physician. The learning objectives were memorisation and implementation of the protocol, use of appropriate communication techniques to deal with the patient's response, and identifying one's own reactions in a stressful situation. Two types of assessments were performed before and after each session: self-assessments by the students and a quantitative and qualitative external assessment by a psychologist and senior physician. In addition, recall of the six-point protocol was assessed during the end-of-the-year examination. RESULTS: Overall, 108 students took part in the course during the 2004-2005 academic year. They felt that their competence improved after each session in terms of the three learning objectives. However, recall of the six-point protocol was inadequate. It was best among students who considered they had progressed most. CONCLUSIONS: Our training course on communication techniques helps students acquire confidence in their skills in breaking bad news by backing theory with practice and feedback. The students make progress despite the psychological stress generated by simulated real-life conditions.