Delivering bad news troubles med students.

• Position: Diagnosis

Incoming medical residents who are about to treat children and teens for the first time believe they are ill-equipped and poorly trained to deliver bad news to young people and their families. A Brown University, Providence, R.I., study recommends additional medical school and residency training in "breaking news of serious diagnoses with patients of different ages."

"Residents just do not get enough medical school education or experience in sharing bad news with younger patients and their families," argues lead author Catherine Dube, who teaches clinical interviewing skills to first-year medical students. "They don't have strategies planned on how to do it, and they need more formal training in those skills. If you haven't observed the breaking of bad news to a young person and their family and you haven't tried it, it is going to be very difficult to do."

The findings are based on self-assessments of 184 medical residents entering programs in pediatrics, internal medicine, and family practice--specialties most likely to diagnose and treat young people. The residents noted their previous training time with adult, pediatric, and adolescent patients, and ranked their comfort levels in sharing bad news with each. Residents were presented with several "bad news" scenarios, such as informing a 70-year-old woman that she has terminal cancer or telling the parents of a 14-year-old that their child has a brain tumor. Respondents anticipated their greatest discomfort discussing serious illness in younger patients and the least discomfort in speaking about that topic to adult and elderly patients.

Twelve percent of residents reported no formal training in pediatric communication skills, and 11% had none for adolescents. More than half surveyed had never observed a pediatric or adolescent "bad news" interaction. In contrast respondents estimated that their...