Einstein/Montefiore Department of Medicine

How do Medical Students Deal with Communicating Uncertainty When Breaking Bad News?

Dr. Rosemarie Conigliaro General Internal Medicine Albert Einstein College of Medicine Montefiore Medical Center Bronx NY
Rosemarie L. Conigliaro, MD

Medical schools offer little formal training in breaking bad news, leaving medical students underprepared to discuss terminal illness and death with patients and families. A study by Dr. Rosemarie Conigliaro seeks to address the effectiveness of trainees’ ability to inform family members about a patient’s death, particularly in cases where the cause of death is unclear.

Dr. Conigliaro and colleague Dr. Kristy Deep at the University of Kentucky developed a standardized patient exercise that presented uncertainty regarding the actual cause of a patient’s death to third-year medical students, and examined how students reported these deaths to surviving family members in simulated scenarios. The study specifically examined both the language that trainees used to disclose the death, and the clinical uncertainty surrounding the death. The study found that a significant proportion of medical students used nonspecific, indirect language to describe death (for example, euphemisms such as "passed away" or "no longer with us"), and many provided a definitive cause—often attributed to familiar diagnoses such as cardiac conditions—even when the actual cause was unspecified.

Failure to teach students that some degree of uncertainty is often inevitable may be a factor, according to investigators. “Many practicing physicians are reluctant to express uncertainty themselves, as they may see this as a threat to their credibility with either their patients or their learners,” Dr. Conigliaro said.

The study, published in late 2015 in the American Academy on Communication in Healthcare's Medical Encounter, recommended that medical students be coached on how to competently yet honestly express uncertainty and limitations regarding diagnosis, treatment, and management choices.

Dr. Conigliaro is Professor of Clinical Medicine (General Internal Medicine), Assistant Dean at Montefiore, and Director of the Internal Medicine Residency Training Program. She has been active in clinical teaching at all levels, including medical students, house staff, fellows, and attending physicians.

Published January 24, 2016 

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