Breaking bad news in neurology: assessing training, perceptions, and preparedness among residency programs in Brazil

ABSTRACT Objective We aimed to evaluate how breaking bad news training was implemented in neurology residency programs in Brazil and to assess the perception and preparedness of trainees and program directors. Methods We performed a cross-sectional descriptive study. Neurology trainees and program directors were recruited from the Brazilian Academy of Neurology registry through convenience sampling. Participants answered a survey evaluating the breaking bad news training at their institution and their preparedness and perception towards the topic. Results We collected 172 responses from 47 neurology institutions from all five socio-demographic regions of Brazil. More than 77% of trainees were dissatisfied with their breaking bad news training, and around 92% of program directors believed their programs required substantial improvement. Approximately 31% of neurology trainees reported never having a lecture about communicating bad news, 66% reported never having a simulated training, and nearly 61% never received feedback regarding their communication abilities. Moreover, 59% of program directors acknowledged that feedback was not a standard practice and nearly 32% reported the absence of any specific training. Conclusion This study suggested that the breaking bad news training in neurology residencies across Brazil is deficient and highlighted challenges to achieve this core competency. Program directors and trainees recognized the importance of the topic, and program directors acknowledged that many factors hinder the ability to implement formal training. Given the relevance of such a skill to patient care, every effort should be made to provide structured training opportunities during residency.

摘要
研究目的：本研究旨在评估巴西神经内科住院医师培训项目中坏消息告知培训（breaking bad news training）的实施现状，并调研受训者与项目主管对此的认知水平及自身准备程度。
研究方法：本研究为横断面描述性研究。通过便利抽样法，从巴西神经病学学会（Brazilian Academy of Neurology）的登记名录中招募神经内科受训者与项目主管。参与者填写问卷，以评估其所在机构的坏消息告知培训情况，以及他们对该主题的准备程度与认知态度。
研究结果：本研究共回收来自巴西全部5个社会人口学区域的47家神经内科机构的172份有效回复。超过77%的受训者对其接受的坏消息告知培训表示不满，约92%的项目主管认为其所在培训项目亟需实质性改进。约31%的神经内科受训者表示从未接受过坏消息沟通相关讲座，66%的受训者表示从未参与过模拟培训，近61%的受训者从未获得过针对其沟通能力的反馈。此外，59%的项目主管承认反馈并未成为标准化实践环节，近32%的项目主管表示所在机构未开展任何针对性的坏消息告知培训。
研究结论：本研究表明，巴西各神经内科住院医师培训项目中的坏消息告知培训存在显著不足，同时凸显了掌握该核心胜任力所面临的诸多挑战。尽管项目主管与受训者均认可该主题的重要性，但项目主管也承认存在诸多阻碍正式培训落地的因素。鉴于该技能对患者诊疗照护的重要性，应尽一切努力在住院医师培训期间提供结构化的培训机会。