Teaching Pediatrics Residents a Communication Framework for Delivering Difficult News: A randomized Controlled Trial of Practice Methods.

Abstract

Objectives: (1) Improve resident skills in delivering difficult news (DDN) by educating pediatrics residents using a communication framework with validity evidence, the m-SPIKES framework. (2) Determine whether small group practice with peer role-play or Rapid Cycle Deliberate Practice (RCDP) simulation is a more effective practice modality for improving DDN.

Methods: IRB-exempt single-institution pilot randomized controlled trial involving twenty-eight pediatrics residents. Residents attended an educational intervention that consisted of a large-group didactic session to learn the m-SPIKES framework followed by randomization into either peer role-play or RCDP groups for small group practice. The residents completed pre- and post-surveys regarding self-efficacy in DDN using a Likert scale and were evaluated for fundamental communication skills and mastery of m-SPIKES by trained faculty during a simulation with a standardized patient before and after the educational intervention. Data was analyzed using bivariate inferential statistical analysis with t-tests.

Results: After the educational intervention, residents in both cohorts were found to have significantly increased self-efficacy in DDN, fundamental communication skills, and overall mastery of the use of m-SPIKES (p=<0.001). The two cohorts had similar improvements in self-efficacy (p=0.223) and fundamental communication skills (p=0.306), however the peer role play showed a significant improvement in mastery of m-SPIKES when compared to the RCDP group (p=0.046).

Conclusions: While this educational intervention demonstrated a significant improvement in DDN skills for all residents in both the peer role-play and RCDP groups, more studies are needed to determine whether the use of RCDP is advantageous in communication education.