TY - JOUR
T1 - The hidden curriculum of breaking bad news
T2 - Identification of three dimensions and four communication patterns
AU - Karnieli-Miller, Orit
AU - Palombo, Michal
AU - Laor, Nathaniel
N1 - Publisher Copyright:
© 2023 Elsevier B.V.
PY - 2023/9
Y1 - 2023/9
N2 - Objectives: To explore students' observations in the hidden curriculum of physicians' breaking bad news interactions and identify dimensions and patterns within them. Methods: We qualitatively analyzed 156 written narrative descriptions of bad news encounters in the clinics written by senior medical students. Results: The analysis identified three dimensions within the encounters: providing information, dealing with emotions, and discussing treatment plans. These dimensions were observed in different proportions, identifying four communication patterns. Half of the encounters focused solely on presenting a treatment plan. Within them, the news was communicated abruptly while neglecting to share information or address emotions. Conclusions: Compared to the main literature on breaking bad news that focuses on two dimensions—the present study identified a third, prominent dimension—discussing the treatment plan. Half of the hidden curriculum experiences contradict the taught protocol, paying little/no attention to emotion and information. Practice implications: When teaching breaking bad news, it is essential to address the day-to-day practices students' observe. Students exposed to these encounters might misinterpret the physician's reliance on a single dimension as best practice. To mitigate this and help recognize their and others' tendency to focus primarily or solely on one dimension, we suggest a simple reflective prompt.
AB - Objectives: To explore students' observations in the hidden curriculum of physicians' breaking bad news interactions and identify dimensions and patterns within them. Methods: We qualitatively analyzed 156 written narrative descriptions of bad news encounters in the clinics written by senior medical students. Results: The analysis identified three dimensions within the encounters: providing information, dealing with emotions, and discussing treatment plans. These dimensions were observed in different proportions, identifying four communication patterns. Half of the encounters focused solely on presenting a treatment plan. Within them, the news was communicated abruptly while neglecting to share information or address emotions. Conclusions: Compared to the main literature on breaking bad news that focuses on two dimensions—the present study identified a third, prominent dimension—discussing the treatment plan. Half of the hidden curriculum experiences contradict the taught protocol, paying little/no attention to emotion and information. Practice implications: When teaching breaking bad news, it is essential to address the day-to-day practices students' observe. Students exposed to these encounters might misinterpret the physician's reliance on a single dimension as best practice. To mitigate this and help recognize their and others' tendency to focus primarily or solely on one dimension, we suggest a simple reflective prompt.
KW - Breaking bad news
KW - Communication
KW - DIagnosis disclosure
KW - Delivering bad news
KW - Hidden curriculum
KW - Teaching communication skills
UR - http://www.scopus.com/inward/record.url?scp=85162245634&partnerID=8YFLogxK
U2 - 10.1016/j.pec.2023.107807
DO - 10.1016/j.pec.2023.107807
M3 - ???researchoutput.researchoutputtypes.contributiontojournal.article???
C2 - 37236123
AN - SCOPUS:85162245634
SN - 0738-3991
VL - 114
JO - Patient Education and Counseling
JF - Patient Education and Counseling
M1 - 107807
ER -