Breaking Bad News in Medical Education: Developing Relational Competencies
Medical Education; Breaking bad news; Physician-patient relationship.
Communication is a clinical skill essential to the development of a satisfactory physician-patient relationship. It is known, however, that good communication contributes to the patient's adherence to the therapeutic proposal, but also can minimize the suffering arising from their health condition through the emotional support provided. Thus, communicating bad news is one of the most difficult tasks of the physician, the need to respond to the patient's emotions empathically, requiring relational skills, which need to be taught in the process of professional training. Despite this, students still have little opportunity, within the formal curriculum, to experience situations of breaking bad news. Therefore, the objective of this study was to implement the teaching of communication of bad news for medical students of UFRN, through the extension project "Dying; a human thing ". This project aims to reflect on death and dying in the context of training, as well as providing opportunities for students to breaking bad news through the Structured Objective Clinical Examination (OSCE). The methodology used was qualitative, descriptive of the case study type. Twenty undergraduate medical students from UFRN participate in the project, per semester. Each semester has 5 meetings, with theoretical-practical discussions. In these meetings, death and dying are discussed in an existential perspective, as well as sharing experiences with professionals from different training areas on strategies to cope with the death of patients. In addition, students are introduced to the Bad News Protocol, SPIKES and communicate difficult news to patients through the OSCE, followed by individual and collective feedback. At the end of the semester of 2018.2, 8 students participated in the Focus Group (GF), in order to analyze the project, highlighting its potentialities and / or weaknesses. The speeches were transcribed and analyzed through the categorical theme proposed by Bardin. After analyzing the material, four categories emerged: (1) motivation / interest for the Dying project, (2) interesting / relevant moments of the project, (3) self-assessment of learning, and (4) suggestions for improving the project. In this context, it is believed that the project contributed to a closer approach to the theme of death, an issue not explored during medical training, but also contributed to the development of communication skills of medical students.