Evidence map›Paper›PMID 40074561›Full record

Trial reportMedical education2025

Improving breaking bad news communication skills through stress arousal reappraisal and worked examples.

Michel Bosshard, Sissel Guttormsen, Urs Markus Nater, Felix Schmitz, Patrick Gomez, Christoph Berendonk

Abstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Medical education, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Trial
  3. Trial
  4. Article
  5. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Michel BosshardInstitute for Medical Education, University of Bern, Bern, Switzerland.ORCID 0009-0005-4663-7888
Sissel GuttormsenInstitute for Medical Education, University of Bern, Bern, Switzerland.
Urs Markus NaterDepartment of Clinical and Health Psychology, University of Vienna, Vienna, Austria.
Felix SchmitzInstitute for Medical Education, University of Bern, Bern, Switzerland.
Patrick GomezDepartment of Occupational and Environmental Health, Unisanté, Center for Primary Care and Public Health & University of Lausanne, Lausanne, Switzerland.
Christoph BerendonkInstitute for Medical Education, University of Bern, Bern, Switzerland.

Funding

Swiss National Science Foundation 100019_200831
6 · The paper itself

Abstract

introductionBreaking bad news (BBN) is a distressing yet essential task in medicine, imposing emotional strain on both physicians and patients. Crucially, effective BBN relies on both verbal and nonverbal communication, which can be impaired by elevated stress associated with the task. Efficient teaching of communication skills continues to present a challenge, and the role of stress management in BBN encounters remains largely overlooked. In this study, we investigated the effects of stress arousal reappraisal (SAR; positive reframing of stress arousal) and worked example (WE; step-by-step demonstration of BBN) interventions on medical students' communication performance.

methodsThis pre-registered randomised controlled trial employed a 2 × 2 between-subjects design to evaluate the individual and combined effects of SAR and WE interventions on the verbal and nonverbal communication performance of 221 third-year medical students. To do so, students completed a 40-min web-based learning module before disclosing bad news to a simulated patient within a 12-min consultation. Performances were videorecorded and assessed by three independent raters.

resultsThe WE intervention significantly improved both verbal and nonverbal communication performance, whereas the SAR intervention enhanced nonverbal communication only. Combining SAR with WE did not yield additional improvements in nonverbal communication beyond those achieved by either intervention alone. DISCUSSION: These findings highlight the potential of both SAR and WE interventions to optimise resource-intensive simulated BBN training. By demonstrating the efficacy of WE in improving both verbal and nonverbal communication, this study advances the literature on the application of WEs in the BBN context. Furthermore, this study is among the first to demonstrate the importance of stress coping in delivering bad news effectively. Given their low threshold, both SAR and WE interventions represent promising tools for equipping medical students with essential BBN communication skills and are well-suited for integration into already time-constrained medical curricula.

Indexed as

CommunicationPhysician-Patient RelationsStress, PsychologicalStudents, MedicalTruth DisclosureAdultArousalClinical CompetenceEducation, Medical, UndergraduateFemaleHumansMaleNonverbal CommunicationPatient Simulation

Identifiers

PMID40074561
PMCPMC12242891

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.