International Journal of Healthcare Simulation

Background:

This simulation aimed to meet the indicative content of a communication module, which focused on breaking bad news. The aim of this session was for first year paramedic students to observe bad news being given in a simulated environment. The objectives were for students to understand the emotive realism [1] behind breaking bad news, highlight the importance of integrating service users into simulated healthcare education, and to recognise the impact of observation and feedback.

Methods:

The first-year paramedic students were introduced to the SPIKES [2] model prior to the event being commended due to its ability to allow patients and relatives to have their own reaction to bad news. The first year students then observed the second and third year students undertake two simulations and used the SPIKES tool to structure feedback on how they broke the bad news. One of the simulations was a cardiac arrest case in which the patient was pronounced deceased by the paramedics, and the second was the treatment of a patient that was suffering from a myocardial infarction. Within both simulations the students were expected to treat the patient utilising best practice and then break the bad news. The final element to this simulation was the inclusion of service users who acted as patients and relatives, and were given the opportunity to feedback as to how they felt during the communication [3].

Results:

We gathered feedback via a Microsoft form from all parties with a total of 23 responses: 11 first year students, five 2^nd and 3^rd year students, and four service users. 17/23 of the participants ‘strongly agreed’ that the day was beneficial to their clinical practice. All participants stated they would want to take part in this educational intervention event again. Service users reported that there was a collegiate atmosphere that was developed between them and the staff. They also appreciated the opportunity to feedback to the students. The main feedback from the observing students was the realistic nature of the day and that they learnt by watching the more experienced students doing the simulation. Students involved in the simulation highlighted that they learnt a lot from the feedback they received and being involved in a realistic simulated environment.

Conclusion:

Overall, this simulation-based activity brought together the theoretical subject matter of communication and created an inclusive learning space for a variety of people to learn.

References

1. Buckman R. How to break bad news: a guide for health care professionals. University of Toronto Press; 1992 Aug 8

2. Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP. SPIKES – a six-step protocol for delivering bad news: application to the patient with cancer. The oncologist. 2000;5(4):302–11.

3. Orr F, Kellehear K, Armari E, Pearson A, Holmes D. The distress of voice-hearing: The use of simulation for awareness, understanding and communication skill development in undergraduate nursing education. Nurse Education in Practice. 2013;13(6):529–35.