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

INTRODUCTION: Breaking 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. METHODS: This 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. RESULTS: The 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.