To use an Objective Structured Clinical Exam (OSCE) as a teaching tool for disclosing a poor prognosis.

Breaking bad news is challenging. OSCEs allow trainees to practice communication skills in a safe learning environment in which mistakes do not adversely affect patients.

In 2017, in conjunction with the NYU School of Medicine Simulation Center, neurology faculty designed an OSCE case in which a resident had to inform a SP her father had severe global hypoxic ischemic injury. The SP assessed the resident’s ability to explain the neurologic findings, and respond to an emotional outburst. After a 10-minute encounter, the resident was provided 5 minutes of feedback. The residents were surveyed on the experience. The SP completed a behavioral anchored checklist to assess the residents’ performance in five domains.

57 third and fourth year neurology residents completed the case from 2018-2020, 54 (95%) of whom completed the post-OSCE survey. Residents reported feeling moderately prepared for the simulation (mean Likert score 3.7/5), rated their performance as average (3.4/5), and felt the case was very helpful (4.6/5). Residents reported difficulty with addressing a complex medical case in a limited amount of time, reacting appropriately to the SP’s emotions, and avoiding medical jargon. The residents performed well in the realms of maintaining professionalism (64% rated “well done”), developing a relationship (62% rated “well done”), and information gathering (61% rated “well done”). There was room for improvement in the realms of providing education and presenting the bad news (39% & 37% rated “partly/not done,” respectively).

OSCE cases can be used to teach clinicians how to discuss prognosis and break bad news. Feedback about this simulation was positive, though its efficacy has yet to be evaluated and could be a future direction of study.