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PURPOSE: To assess the level of residents' competence in delivering bad news to patients. METHOD: In June 1995, 25 residents (of 116) in the Wayne State University general internal medicine residency program volunteered to participate in the study, which consisted of videotaped interviews of a simulated patient whose profile had been developed to highlight the delivery of a diagnosis of lung cancer. The residents were evaluated using an instrument based on a review of the current literature regarding the skills considered necessary for giving bad news in a caring and informative manner. The instrument contained 16 items, seven in the informative category and nine in the affective category. Each item was rated on a five-point Likert scale (from 1 = “doesn't do this” to 5 = “does this very well”). A rating of > or = 4 on any item indicated competence in the skill area measured by that item. All interviews included in the study were rated by all six of the authors. Interrater reliability was calculated to be .91. RESULTS: In all, 22 interviews (three by women, 19 by men) were included in the study. The residents' ages ranged from 26 to 35 years; the numbers of years since graduation from medical school ranged from two to six. Twenty were third- or fourth-year residents ready to graduate; the other two were completing their first year. Mean ratings in the informative category ranged from 1.51 to 4.51; for three items, mean ratings were > or = 4. The total mean rating for all the items in this category was 3.42. Mean ratings in the affective category ranged from 1.15 to 4.75; for three items, mean ratings were > or = 4. The total mean rating for all the items in this category was 3.45. CONCLUSION: The residents showed a general lack of competence in delivering bad news. The skill items with the lowest ratings were primarily related to eliciting the patient's perspective, which may represent a weakness on the part of the residency program in teaching the residents to use a “patient-centered” interviewing style. The results of this study will form the basis of a curriculum to improve residents' comfort with and skills for delivering bad news to patients.