***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : Although patients with cancer are often accompanied by a relative during breaking bad news ( BBN ) consultations , little is known regarding the efficacy of training programmes design ed to teach residents the communication skills needed to break bad news in a triadic consultation . Methods : Residents were r and omly assigned to a 40-h dyadic and triadic communication skills training programme  ( n=48 ) or a  waiting list ( n=47 ) . A simulated BBN triadic consultation was audiotaped at baseline , and after training for the training group , and 8 months after baseline for the waiting list group . Transcripts were analysed using content analysis software ( LaComm ) . A coder determined the moment of bad news delivery and the relative ’s first turn of speech regarding the bad news . A generalised estimating equation was used to evaluate residents ’ communication skills , BBN timing , and the relative ’s inclusion in the consultation . Results : Ninety-five residents were included . After training , the duration of the pre-delivery phase was found to be longer for the trained residents ( relative risk (RR)=3.04 ; P<0.001 ) . The simulated relative ’s first turn of speech about the bad news came more often during the pre-delivery phase ( RR=6.68 ; P=0.008 ) , and was more often initiated by the trained residents ( RR=19.17 ; P<0.001 ) . Trained residents also used more assessment ( RR=1.83 ; P<0.001 ) and supportive utterances ( RR=1.58 ; P<0.001 ) . Conclusion : This study demonstrates that a training programme that focuses on the practice of dyadic and triadic communication skills can improve the communication skills of the participating residents in a BBN triadic consultation . Such a training should be included in resident curriculum Abstract Objective : Although communication skills represent an increasingly important aspect of medical care , little has been done to assess the best method of teaching these skills . Our study was design ed to assess simulation-debriefing compared to lecture in teaching skills for Breaking Bad News ( BBN ) in obstetrics . Methods : This is a r and omized prospect i ve trial of house staff from a large academic medical center . Subjects initially underwent baseline simulation , followed by evaluation on BBN skills by themselves , a faculty observer , and the st and ardized patient ( SP ) . The subjects were then immediately r and omized to a debriefing session by faculty or to a lecture about BBN . Subsequently , both groups underwent a second simulation with the same three assessment s , yielding post-intervention data . Results : 35 subjects completed both simulations . Both debriefing and lecture curricula showed improvement in scores by self ( p = 0.010 ) and faculty ( p < 0.001 ) . The debriefing group improved significantly more than the lecture group for self-evaluation ; additionally , improvements were greater for the debrief group in verbal and nonverbal skills . Long-term follow-up three months after both interventions demonstrated continued improvement in BBN . Conclusions : Simulation training with debriefing is effective for teaching communication skills , and superior to lecture for self-perceived improvement . Long-term follow-up suggested retention of confidence in BBN skills Background : Physician-patient communication skills help determine the nature and quality of diagnostic information elicited from patients , the quality of the physician 's counseling , and the patient 's adherence to treatment . In spite of their importance , surveys have demonstrated a wide variability and deficiencies in the teaching of these skills . Aim : Describe two specific method ologies for teaching physician-patient communication skills developed at our institution and pilot test them for effectiveness . Methods : Between 2004 and 2009 we developed “ doc.com , ” a series of 41 media-rich online modules on all aspects of healthcare communication jointly with the American Academy on Communication in Healthcare . Starting in 2006 , we exp and ed our pre-existing experience with the videoconferencing system “ WebOSCE ” into the online application “ WebEncounter . ” This new methodology combines practice of communication skills on st and ardized patients with structured assessment and constructive feedback . We had three r and omized groups : controls who did only the assessment parts of a WebOSCE on two occasions , a doc.com group who had doc.com in between the assessment occasions , and a combined group that had both doc.com and a WebEncounter between assessment s. Results / Conclusion : We found significant improvement in skills as components were added , and the training program was well received BACKGROUND Previous end-of-life and palliative care curricula for surgical residents have shown improved learner confidence , but have not measured cognitive knowledge or skill acquisition . METHODS A nonr and omized trial evaluated a structured palliative care curriculum for  7 postgraduate year 2 surgical residents ( intervention group ) compared with 6 postgraduate year 5 surgical residents ( comparison group ) . Outcomes were measured using an 18-item knowledge test , a 20-minute objective structured clinical examination simulating an intensive care unit family conference , and a survey measuring self-confidence . RESULTS The mean knowledge test scores for the intervention group , both before and after undergoing the structured palliative care curriculum , were no different from the comparison group . There was also no difference in objective structured clinical examination scores between the 2 groups . The intervention group felt less comfortable managing pain , breaking bad news , or addressing ethical issues . CONCLUSIONS Junior surgical residents have similar palliative care knowledge to senior residents without a palliative care curriculum . After participating in a palliative care curriculum , they have simulated skills that are similar to chief residents . However , self-confidence is lower among junior residents despite undergoing a palliative care curriculum Intensive care medical and nursing staff self-rate their communication skills as improved following attendance at the European Donor Hospital Education Programme ( EDHEP ) workshop . A prospect i ve study was conducted to determine what impact EDHEP has on communication skills .  Doctor-nurse pairs from 10 experimental and 10 control Intensive Care Units undertook two st and ardized simulated relative encounters ( Breaking Bad News and Donation Request ) at three measurement points ( pre , post and follow-up ) . Nurses showed no change in communication skills . Experimental group doctors showed significant improvement in breaking bad news and requesting donation ; most of these improvements were not maintained . Control group doctors showed some improvement in breaking bad news , indicating that participating in measurement by itself initiates some transient change in communication skills . Attendance at EDHEP does lead to significant improvement in some , but not all , communication skills essential in breaking bad news and requesting donation . Further research is necessary to determine what factors additional to EDHEP will contribute to enduring change in these particular skills BACKGROUND Internal medicine residents are largely unprepared to carry out end-of-life ( EOL ) conversations . There is evidence that these skills can be taught , but data from r and omized controlled trials are lacking . PURPOSE We studied whether a day-long communication skills training retreat would lead to enhanced performance of and confidence with specific EOL conversations . We also studied the effect of the retreat on residents ' ability to respond to patient emotions . METHODS PGY-2 resident volunteers were r and omly assigned to a retreat group or a control group . The retreat involved a combination of teaching styles and skills practice with st and ardized patients . All participants completed question naires and were evaluated carrying out two types of conversations ( breaking bad news or discussing direction of care ) with a st and ardized patient before ( T1 ) and after ( T2 ) the intervention phase . Conversations were audio-taped and later rated by a research er blinded to group assignment and time of assessment . RESULTS Forty-nine residents agreed to r and omization ( 88 % ) with 23 residents r and omized to the retreat group and 26 to the control group . Compared to controls , retreat participants demonstrated higher T2 scores for breaking bad news , discussing direction of care , and responding to emotion . Comparing T2 to T1 , the retreat group 's improvement in responding to emotion was statistically significant . The retreat group 's confidence improved significantly only for the breaking bad news construct . CONCLUSIONS A short course for residents can significantly improve specific elements of resident EOL conversation performance , including the ability to respond to emotional cues OBJECTIVE Breaking bad news ( BBN ) is a complex task which involves dealing cognitively with different relevant dimensions and a challenging task which involves dealing with intense emotional contents . No study however has yet assessed in a r and omized controlled trial design the effect of a communication skills training on  residents '  physiological arousal during a BBN task . METHODS Residents '  physiological arousal was measured , in a r and omized controlled trial design , by heart rate and salivary cortisol before , during and after a BBN simulated task . RESULTS Ninety-eight residents were included . MANOVA showed significant group-by-time effects . Trained residents '  mean heart rate levels remained elevated after training and cortisol areas under the curve increased after training compared to untrained residents . CONCLUSION Communication skills training has an effect on residents ' physiological arousal . Residents ' self-efficacy and communication skills improvements in a BBN simulated task are associated with an elevated physiological arousal , which becomes proportional to the complexity of the task and reflects a better engagement and performance . PRACTICE IMPLICATION S Residents should be informed that , to perform a task , they need to engage in the task with a physiological arousal proportional to the complexity of this task . Communication skills training should be adapted Purpose High- quality palliative care requires physicians who communicate effectively , yet many do not receive adequate training . Leading efforts to demonstrate the effectiveness of such training have involved time-intensive programs that included primarily attending physicians , which have been conducted outside of the United States . The goal was to evaluate the effect of a short course to improve residents ' communication skills delivering bad news and eliciting patients ' preferences for end-of-life care . Method This prospect i ve trial enrolled internal medicine residents at Duke University Medical Center from 1999 to 2001 . The course consisted of small-group teaching with lecture , discussion , and role-play . The outcome measure was observed communication skills delivering bad news and eliciting patients ' preferences for end-of-life treatment , assessed via audio-recorded st and ardized patient encounters before and after receiving the intervention . Results Thirty-seven residents received the intervention and 19 were in the control group . Residents attending the course demonstrated statistically significant increases in their overall skill ratings in the delivery of bad news , with improvement in the specific areas of information giving and responding to emotional cues . Although cumulative scores for discussion s about patient preferences for treatment did not increase , residents demonstrated enhanced specific skills including discussing probability , presenting clinical scenarios , and asking about prior experience with end-of-life decision making . Conclusion A relatively short , intensive course can improve the end-of-life communication skills of U.S. medical residents BACKGROUND Physicians typically learn to communicate bad news to patients through trial and error or observation of more senior physicians . To give medical students initial instruction and experience in this area , we developed two st and ardized patient instructor ( SPI ) experiences in " breaking bad news . " METHODS Twenty-one junior medical students had an SPI experience discussing a new diagnosis of rectal cancer or pregnancy loss . These 21 students , and 17 students having neither experience , interviewed the pregnancy loss SPI on the clinical performance examination ( CPE ) at the end of the junior year . RESULTS Students who had previously had a " breaking bad news " SPI experience performed significantly better on the CPE pregnancy loss station than students without this experience . There was no significant difference in performance between students who had previously had the pregnancy loss versus rectal cancer SPI . CONCLUSIONS This research provides evidence for the effectiveness of bad news communication skills teaching , and its potential for transfer across content areas PURPOSE The aim of this study was to identify the effects of a communication skills training ( CST ) program for oncologists , developed based on patient preferences regarding oncologists ' communication . PARTICIPANTS AND METHODS Thirty oncologists were r and omly assigned to either an intervention group ( IG ; 2-day CST workshop ) or control group ( CG ) . Participants were assessed on their communication performance during simulated consultation and their confidence in communicating with patients at baseline and follow-up . A total of 1,192 patients ( response rate , 84.6 % ) who had consultations with the participating oncologists at baseline and /or follow-up were assessed regarding their distress using the Hospital Anxiety and Depression Scale , satisfaction with the consultation , and trust in their oncologist after the consultation . RESULTS At the follow-up survey , the performance scores of the IG had improved significantly , in terms of their emotional support ( P = .011 ) , setting up a supportive environment ( P = .002 ) , and ability to deliver information ( P = .001 ) , compared with those of the CG . Oncologists in the IG were rated higher at follow-up than those in the CG in terms of their confidence in themselves ( P = .001 ) . Patients who met with oncologists after they had undergone the CST were significantly less depressed than those who met with oncologists in the CG ( P = .027 ) . However , the CST program did not affect patient satisfaction with oncologists ' style of communication . CONCLUSION A CST program based on patient preferences is effective for both oncologists and patients with cancer . Oncologists should consider CST as an approach to enhancing their communication skills OBJECTIVE We have previously described a breaking bad news ( BBN ) training program for primary care physicians [ Ungar L , Alperin M , Amiel GE , Beharier Z , Reis S. Breaking bad news : structured training for family medicine residents . Patient Educ Couns 2002;48:63 - 68 ] . In this paper , we present the assessment of an educational intervention aim ed at improving this important skill . METHODS The assessment tool was an eight station objective structured clinical examination ( OSCE ) utilizing st and ardized patients ( SPs ) . Intervention and control groups of 17 general practitioners ( GP ) each were evaluated before and after an educational intervention , or a Balint group ( control ) . RESULTS Intervention group GPs significantly increased their average grade on the post-test as compared to the pre-test ( 58.5 
    Output:
    
Conclusions Interventions are effective for improving news delivery and physician confidence .