Handling consultations in which distressing information is given : the effects of an interactive teaching programme on the performance of fifth year medical students and junior house officers
Technological advances mean that medical education bodies can now teach doctors in training using sophisticated engineering systems. Clearly, it is important to establish the efficacy of such innovative educational methods. This study was undertaken primarily to determine whether or not an interactive computerised teaching programme could train medical students and junior house officers to impart effectively distressing information. Subjects were fifth year medical undergraduates at the University of Aberdeen during the 1997/98 academic year. Subjects were separated into two groups. One group had access to the teaching programme during their final undergraduate year, whilst the other did not. Subjects conducted simulated interviews toward the end of their fifth year at medical school and toward the end of their pre-registration year. All subjects were assessed on one of three cases. Subjects were assessed on the same case at both assessment points. All interviews were videotaped. Performances were scored independently by two raters. Subjects rated their own performances. Of 132 medical undergraduates, 94 (71%) conducted interviews toward the end of their fifth year. Of the 63 who could participate one year later, 45 (71%) conducted a second assessment interview. The interaction teaching programme did not improve subjects' ability to give bad news at either test point. Regarding subjects' ratings, at the undergraduate test point, the two significant differences favoured those subjects given access to the teaching programme. At the postgraduate assessment point, the four significant differences favoured those subjects not given access to the teaching programme. Analyses indicated that the skills of doctors in training could be reliably evaluated using three ten-minute interviews. Subjects were poor at evaluating their own communication skills. Those who gave bad news more frequently as junior house officers performed at a similar level to those who gave bad news less frequently. The implications for medical education are discussed.