Delivering Bad News in Obstetrics and Gynecology Residency: A Pilot Curriculum to Address Identified Training Gaps

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Abstract

BACKGROUND:

A recent literature review identified no publications on resident training in diagnosing and counseling patients on fetal demise. A previous needs assessment identified resident training gaps in the following areas: 1) communication skills in delivering bad news, 2) bereavement support and 3) counseling and consenting for the postmortem evaluation of the stillborn.

METHODS:

A 3-pronged curriculum, created and implemented to address the identified needs, included: directed readings, didactic lectures, and standardized patient simulation. Residents were surveyed pre and post-intervention to assess impact of the curriculum. Results were compared using McNemar's Test.

RESULTS:

Fourteen of 21 residents completed the curriculum. Resident self-assessed confidence significantly increased in: initiating proper workup after stillbirth (85.7% post versus 50% pre-intervention, P=.025), addressing patient anxiety and grief (100% post versus 71.43% pre, P=.045), and consenting for autopsy (100% post versus 50% pre, P=.008). The curriculum successfully addressed the gaps in training identified in grief management and autopsy counseling. A post-intervention objective measure demonstrated significant improvement in resident knowledge.

DISCUSSION:

This novel curriculum significantly improved residents' confidence and competence in diagnosing and counseling a fetal demise. Our department has integrated this successful training program into the residents' formal curriculum. We are sharing it as a model with neighboring institutions to further evaluate and expand this project.

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