Development of a Simulation-Based Mastery Learning Curriculum for Breaking Bad News

Julia H. Vermylen*, Gordon J. Wood, Elaine R. Cohen, Jeffrey H. Barsuk, William C. McGaghie, Diane B. Wayne

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

37 Scopus citations


Introduction: Physician communication impacts patient outcomes. However, communication skills, especially around difficult conversations, remain suboptimal, and there is no clear way to determine the validity of entrustment decisions. The aims of this study were to 1) describe the development of a simulation-based mastery learning (SBML) curriculum for breaking bad news (BBN) conversation skills and 2) set a defensible minimum passing standard (MPS) to ensure uniform skill acquisition among learners. Innovation: An SBML BBN curriculum was developed for fourth-year medical students. An assessment tool was created to evaluate the acquisition of skills involved in a BBN conversation. Pilot testing was completed to confirm improvement in skill acquisition and set the MPS. Outcomes: A BBN assessment tool containing a 15-item checklist and six scaled items was developed. Students' checklist performance improved significantly at post-test compared to baseline (mean 65.33%, SD = 12.09% vs mean 88.67%, SD = 9.45%, P < 0.001). Students were also significantly more likely to have at least a score of 4 (on a five-point scale) for the six scaled questions at post-test. The MPS was set at 80%, requiring a score of 12 items on the checklist and at least 4 of 5 for each scaled item. Using the MPS, 30% of students would require additional training after post-testing. Comments: We developed a SBML curriculum with a comprehensive assessment of BBN skills and a defensible competency standard. Future efforts will expand the mastery model to larger cohorts and assess the impact of rigorous education on patient care outcomes.

Original languageEnglish (US)
Pages (from-to)682-687
Number of pages6
JournalJournal of Pain and Symptom Management
Issue number3
StatePublished - Mar 2019


  • Simulation-based mastery learning
  • assessment tool
  • breaking bad news
  • communication skills training
  • entrustment
  • minimum passing standard

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine
  • General Nursing


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