Breaking Bad News for Anesthesia Residents: A Validity Study of a Simulation Based Education Intervention

Background: Breaking bad news (BBN) to patients and their relatives is a complex task. The structure, training methods or evaluation instruments that are best used to teach and assess BBN to anesthesiology residents are still unclear. The purpose of this study is to examine the validity evidence supporting the use of a previously published ‘‘GRIEV_ING” assessment tool in measuring the acquisition of BBN skills for anesthesiology residents after an educational intervention. Methods: Sixteen third and fourth-year residents participated in this study. The GRIEV_ING” checklist was modified, pilot tested and reviewed by content experts to accommodate the anesthesia context. Examiners and standardized patiens (SPs) underwent frame-of-reference training sessions in preparation for their roles. BBN skills were assessed via videotaped SP encounters after immersive scenarios, at baseline and immediately post-intervention with two different cases. A communication global rating and the GRIEV_ING” assessment tool were used. Residents’ perception about their own ability and comfort for BBN were collected using the pre and post workshop surveys. A focus group interview was conducted. Inter-rater reliability was evaluated by intraclass correlation coefficient (ICC). Internal-consistency reliability and correlation between the two assessments instruments was calculated. An item analysis for the GRIEV_ING scale was conducted. Differences in performance, based on the years of training, and previous experience or training were compared. Results: ICCs for both cases indicated good inter-rater reliability for the GRIEV_ING checklist and a good internal-consistency reliability for both assessment instruments was found. Item analysis on the GRIEV_ING checklist items showed that 40.7% of items had an excellent discrimination power. Performance did not show significant differences when based on years of training, previous training or experience. Concepts from the focus group discussions were organized into categories that included residents' perceived barriers to BBN; strategies for BBN, strengths of the education intervention and training needs. Conclusions: Findings from this study indicate that BBN is a teachable skill. The evaluation of our education intervention provides validity evidence to illustrate the value of integrating BBN into the curriculum of the anesthesiology residents, which has led to improved learner performance.