Breaking Bad News Training in the Era of COVID-19 Pandemic: The Role of Simulation Based Learning.

To the Editor:

I commend Dr Soosaipillai and colleagues on their excellent commentary regarding breaking bad news training in the era of COVID-19.[1] My comments are focused on the importance of including training modules related to pandemic delivery of bad news in simulation based learning. The COVID-19 global pandemic has introduced novel challenges in delivering bad news. Scenarios such as explaining decisions on allocation of scare resources—which have often been used as hypothetical cases to illustrate ethical dilemmas—are now turning into real-world scenarios as demands for intensive care beds may exceed hospital capacities due to the ongoing COVID-19 pandemic. Delivering the news to the family members of a terminally ill patient with COVID-19 that a virtual farewell may be their only chance to say goodbye to their loved one is another instance of novel challenges imposed by this pandemic. Several components of commonly used protocols such as the SPIKES[2] model for delivering bad news may be very challenging to follow due to the remote nature of the conversation and the uncertainties surrounding this pandemic resulting in additional complexities in prognostication. As such, there exists an urgent need in post-graduate medical training to build competence in dealing with the novel challenges in delivering bad news in relation to this pandemic particularly death due to COVID-19. With the increasing need for redeploying health care providers to respond to COVID-19, acquiring this competence will even be more critical. There is no widely accepted learning module specific for communication skills training related to challenges posed by COVID-19. However, this is where simulation based training and virtual reality tools for delivering bad news—beyond standardized patient scenarios—can play a significant role in promoting readiness among the next generation of health care providers.[3-5] Simulation based learning is a powerful training tool which applies technology advances to provide learners with a realistic and immersive experience.[6] It allows the learners to acquire practical hands-on experience that is similar to a real-life clinical setting. This is specifically invaluable for providing learners with quick experience in handling challenging situations such as breaking bad news. With creative, interactive, and innovative technological features, simulation based training can even inspire fatigued learners and teachers who may feel overwhelmed by the unprecedented transition to online learning during the COVID-19 pandemic. At any rate, it is crucial to help future clinicians develop a flexible repertoire of communication skills to enable them to innovate and adapt in response to novel yet challenging situations during a pandemic.