When doctors have to impart bad news to their patients or their families, they are sometimes at a loss as to how to do so in a supportive yet helpful way. 

A workshop called “Breaking Bad News” offered to residents and senior residents as part of the current Centre for Resident and Faculty Development (CRAFD) curriculum has been receiving good reviews. 

Said Ms Koh Sock Sim, Principal Medical Social Worker and instructor at the workshop, “Although we cannot change the nature of the bad news we have to deliver, we can learn how to deliver it in a sensitive and empathic manner to our patients.”

The course focuses on teaching the six-step protocol to help residents learn how to give bad news in a sensitive manner. The SPIKES protocol was first developed by the University of Texas MD Anderson Cancer Centre. 
​MSW-run course ranks high among junior doctors






Conducted by the Medical Social Services Department, SGH’s half-day workshop introduces the step-by-step guide to residents before the course. After the protocol has been explained, residents are broken into smaller groups to do role-play.  

The role play situation centres round a patient and family who are played by actors. Written by SingHealth Residency CRAFD’s Medical Educator, Mr Joselito Balingit, the scenarios are customised to the clinical specialties of the residents.

“Although we cannot change the nature of the bad news we have to deliver, we can learn how to deliver it in a sensitive and empathic manner to our patients.” 

Senior Medical Social Worker Andy Sim explained, “The residents have to respond to the role-play scenarios which challenge them to confront their discomfort, vulnerabilities and blind spots. 

"Residents have told us that learning in a safe classroom environment has helped them discover their unique coping mechanisms to stressful and difficult interactions by allowing them to make mistakes and learn from them.”  

The course was first developed by the department as it saw a need to train nurses who had to help patients struggling to cope with bad news, such as about a terminal illness.

“Management later felt that the course was important for doctors as well. Hence, the course evolved to incorporate a practical component that helps residents integrate learning into real-life situations,” explained Sock Sim. “In fact, we have even customised the course to train police staff before.” 

Besides the Breaking Bad News workshop, residents can attend communication courses such as Applied Suicide Intervention Skills Training (ASIST), Training for Advance Care Planning, and Essential Counselling Skills.

Breaking Bad News

The course helps participants to: 

  1. Define bad news and recognise the impact of bad news on patients and their families
  2. Identify and relate to the difficulties and challenges physicians face when breaking bad news
  3. Learn and understand the six-step protocol for delivering bad news, and how to apply the steps in communicating bad news

More information on the Breaking Bad News course can be found at http://crafd.com.sg/crafd-trainingcalendar-ay-2013-14/