From threat to challenge-Improving medical students' stress response and communication skills performance through the combination of stress arousal reappraisal and preparatory worked example-based learning when breaking bad news to simulated patients: study protocol for a randomized controlled trial

Autor(en)

Michel Bosshard, Felix Michael Schmitz, Sissel Guttormsen, Urs Markus Nater, Patrick Gomez, Christoph Berendonk

Abstrakt

Background: Breaking bad news (BBN; e.g., delivering a cancer diagnosis) is perceived as one of the most demanding communication tasks in the medical field and associated with high levels of stress. Physicians’ increased stress in BBN encounters can negatively impact their communication performance, and in the long term, patient-related health outcomes. Although a growing body of literature acknowledges the stressful nature of BBN, little has been done to address this issue. Therefore, there is a need for appropriate tools to help physicians cope with their stress response, so that they can perform BBN at their best. In the present study, we implement the biopsychosocial model of challenge and threat as theoretical framework. According to this model, the balance between perceived situational demands and perceived coping resources determines whether a stressful performance situation, such as BBN, is experienced as challenge (resources > demands) or threat (resources < demands). Using two interventions, we aim to support medical students in shifting towards challenge-oriented stress responses and improved communication performance: (1) stress arousal reappraisal (SAR), which guides individuals to reinterpret their stress arousal as an adaptive and beneficial response for task performance; (2) worked examples (WE), which demonstrate how to BBN in a step-by-step manner, offering structure and promoting skill acquisition. Methods: In a randomized controlled trial with a 2 (SAR vs. control) x 2 (WE vs. control) between-subjects design, we will determine the effects of both interventions on stress response and BBN skills performance in N = 200 third-year medical students during a simulated BBN encounter. To identify students’ stress responses, we will assess their perceived coping resources and task demands, record their cardiovascular activity, and measure salivary parameters before, during, and after BBN encounters. Three trained raters will independently score students’ BBN skills performances. Discussion: Findings will provide unique insights into the psychophysiology of medical students who are tasked with BBN. Parameters can be understood more comprehensively from the challenge and threat perspective and linked to performance outcomes. If proven effective, the evaluated interventions could be incorporated into the curriculum of medical students and facilitate BBN skills acquisition. Trial registration: ClinicalTrials.gov (NCT05037318), September 8, 2021.

Organisation(en)

Institut für Klinische und Gesundheitspsychologie, Forschungsplattform The Stress of Life - Processes and Mechanisms underlying Everyday Life Stress

Externe Organisation(en)

Universität Bern, Université de Lausanne

Journal

BMC Psychology

Band

11

DOI

https://doi.org/10.1186/s40359-023-01167-6

Publikationsdatum

12-2023

Peer-reviewed

Ja

ÖFOS 2012

501010 Klinische Psychologie

Schlagwörter

ASJC Scopus Sachgebiete

Allgemeine Psychologie

Sustainable Development Goals

SDG 3 – Gesundheit und Wohlergehen

Link zum Portal

https://ucrisportal.univie.ac.at/de/publications/756b74ec-0af6-4063-b96d-c8bce7265243