The impact of early breaking bad news education: a qualitative study into students' self-reported take-home messages

Introduction: This study investigated the self-reported take-home messages of medical students after an early training module in breaking bad news (BBN). The findings will aid the discussion on how to teach BBN. Methods: We asked 592 second year medical students at two Dutch medical schools to write down what they had learned, right after their first communication skills training in BBN. We analysed these self-reported take-home messages using a hybrid form of qualitative content analysis using SPIKES as a conceptual frame. Results: The most important take-home messages reported by students in both schools were: how to inform the patient (24,5%), how to deal with emotions (20,6%), and how to prepare for a BBN-consultation (16,9%). Additionally, students reported the professional quality "being patient-centered". Conclusions: Early communication skills training on BBN, including true stories and examples of doctors and their BBN-experiences, does not only give the students the knowledge how to break bad news to patients, but also which underlying professional qualities are needed to successfully break bad news. Good role models and realistic examples are therefore important. We propose a new mnemonic PRINSE (PReparation-INformation-Silence-Emotions) for novice learners in the design of a helical curriculum.