The development of a structured rating schedule (the BAS) to assess skillsin breaking bad news

There has been considerable interest in how doctors break bad news, with ca lls from within the profession and from patients for doctors to improve the ir communication skills, In order to aid clinical training and assessment o f the skills used in breaking bad news there is a need for a reliable, prac tical and valid, structured rating schedule. Such a rating schedule was com piled from agreed criteria in the literature, Video-taped recordings of sim ulated consultations breaking bad news were independently assessed by three raters using the schedule and compared to three experts who gave global ra tings. The primary outcome measures were internal consistency of the schedu le and level of agreement between raters. The internal consistency was high with a Cronbach's alpha of 0.93. Agreement between raters using the schedu le was moderate to good. The majority of the variation in scores was due to the differences in skills demonstrated in the interviews. The agreement be tween raters not using the schedule was poor. The BAS provides a simple to use, reliable, and consistent rating schedule for assessing skills used in breaking bad news. It could be a valuable aid to teaching this difficult ta sk.