AN ASSESSMENT OF RESIDENTS COMPETENCE IN THE DELIVERY OF BAD-NEWS TO PATIENTS

Purpose. To assess the level of residents' competence in delivering ba d news to patients. Method. In lune 1995, 25 residents (of 116) in the Wayne State University general internal medicine residency program vo lunteered to participate in the study, which consisted of videotaped i nterviews of a simulated patient whose profile had been developed to h ighlight the delivery of a diagnosis of lung cancer. The residents wer e evaluated using an instrument based on a review of the current liter ature regarding the skills considered necessary for giving bad news in a caring and informative manner. The instrument contained 16 items, s even in the informative category and nine in the affective category. E ach item was rated on a five-point Likert scale (from 1 = ''doesn't do this'' to 5 = ''does this very well''). A rating of greater than or e qual to 4 on any item indicated competence in the skill area measured by that item. All interviews included in the study were rated by all s ix of the authors. Interrater reliability was calculated to be .91. Re sults. In all, 22 interviews (three by women, 19 by men) were included in the study. The residents' ages ranged from 26 to 35 years; the num bers of years since graduation from medical school ranged from two to six. Twenty were third- or fourth year residents ready to graduate; th e other two were completing their first year. Mean ratings in the info rmative category ranged from 1.51 to 4.51; for three items, mean ratin gs were greater than or equal to 4. The total mean rating for all the items in this category was 3.42. Mean ratings in the affective categor y ranged from 1.15 to 4.75; for three items, mean ratings were greater than or equal to 4. The total mean rating for all the items in this c ategory was 3.45. Conclusion. The residents showed a,general lack of c ompetence in delivering bad news. The skill items with the lowest rati ngs were primarily related to eliciting the patient's perspective, whi ch may represent a weakness on the part of the residency program in te aching the residents to use a ''patient-centered'' interviewing style. The results of this study will form the basis of a curriculum to impr ove residents' comfort with and skills for delivering bad news to pati ents.