Breaking bad news: Use of cancer survivors in role-playing exercises

Purpose: To teach medical students how to deliver a diagnosis of cancer using role-play with a cancer survivor volunteer. Method: Medical students participated in a curricular module on "breaking bad news." Its novel aspect was the inclusion of role-playing exercises during which the student communicated the initial diagnosis of cancer to a cancer survivor volunteer. The clinical scenario was based on the volunteer's own history of cancer. The exercise required the student to become knowledgeable about the volunteer's cancer and its mode of presentation, deliver the diagnosis using previously demonstrated methods, and then receive verbal feedback from the volunteer. A panel discussion with the cancer survivor volunteers concluded the module. The efficacy of this curricular module was assessed by the students' performance during the role-playing exercise, gain in confidence in communicating bad news, and overall rating of the learning experience. Results: The interaction of the students with the cancer survivors was the strength of this curriculum, providing the students with an important perspective on physician-patient relationships and coping with cancer. The students demonstrated a high level of adherence to preferred communication techniques, gained significant confidence with the task of "breaking bad news," and were very satisfied with the module. Participation in these role-playing exercises by the cancer survivor volunteers was viewed as emotionally demanding but also rewarding. Recruitment and retention of the volunteers were not obstacles to this activity. Conclusion: Role-playing with cancer survivor volunteers can be an effective method of teaching medical students how to communicate bad news.