The Use of Simulation in Medical Student Education on the Topic of Breaking Bad News


Thomas Dale MacLaine
University of Warwick
Nicholas Lowe
University of Warwick
Jeremy Dale
University of Warwick


Breaking Bad News (BBN) is a critical skill for doctors when disclosing life-changing information with patients. Simulated patients (SPs) are widely used to develop communication skills, though the best method to engage them in undergraduate BBN medical education is unclear.

We searched 14 databases with the search terms “Medical education”, “Patient simulation”, “Bad news”. Two independent blinded reviewers screened articles by title and abstract, followed by full text review. Full texts were checked for quality and bias, before their inclusion into the review. Data was systematically extracted and thematic analysis was used to identify themes and subthemes within the selected articles.

Out of the 2117 articles screened, 29 publications met the inclusion criteria. Studies investigate a variety of simulated patient models, including actors as patients (65.5%), peers (7.0%), and cancer survivors (3.5%). Several models exist for training BBN, which is done at varying times in undergraduate medical training. Students report needing additional guidance with BBN between training and clinical exposure. Our thematic analysis centres around two overarching themes: intrinsic components of BBN, and the validation of models used in BBN consultations.

 Key messages

SPs are beneficial for training BBN, allowing students to practice vital communication skills without detriment to patient care. Students may benefit from top-up training or support when using BBN skills in practice. Several models used to deliver BBN training are published, with limited literature comparing effectiveness.

December 30, 2020