gms | German Medical Science

Jahrestagung der Gesellschaft für Medizinische Ausbildung (GMA)

14.09. - 17.09.2016, Bern, Schweiz

Which types of web-based worked examples on breaking bad news are most suitable to foster communication skills in 4th year medical students? Results from a randomised field trial

Meeting Abstract

  • corresponding author presenting/speaker Felix Schmitz - Bern, Schweiz
  • Kai Schnabel - Bern, Schweiz
  • Adrian Göldlin - Bern, Schweiz
  • Ulrich Woermann - Bern, Schweiz
  • Sissel Guttormsen - Bern, Schweiz

Jahrestagung der Gesellschaft für Medizinische Ausbildung (GMA). Bern, 14.-17.09.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocV19-337

doi: 10.3205/16gma134, urn:nbn:de:0183-16gma1345

Published: September 5, 2016

© 2016 Schmitz et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



Background: Appropriate physician communication is associated with positive patient­-related outcomes [1]. Thus, communication is an essential part of most medical education curricula. In Switzerland communication skills are also tested in the Federal Licensing Examination [2]. As students are requested to apply communication principles properly, training with simulated patients is strongly recommended [3]. However, to enable the students to benefit from this training, they must first familiarise with (the application of) those communication principles.

Aim: In this randomised field study, a worked example approach [4] was implemented in a web-based learning environment. The aim was to facilitate the students’ acquisition of communication skills with respect to breaking bad news to patients.

Methods: N=116 fourth year medical students were randomly allocated to one of three learning conditions (LC) with either written worked examples (LC1), video-based worked examples (LC2), or video-based worked examples with content-dependent cues (LC3). All examples provided exactly the same information with respect to the learning contents (breaking bad news); they only differed in presentation. The cues were short text labels. Every cue displayed the rationale for a respective sequence within the example (e.g. "giving knowledge to the patient"). Learning outcomes were derived from the students’ first attempt to break bad news to a simulated patient (up to 10 points).

Results: Participants from LC3 attained the highest performance scores (MLC3=3.53 > MLC2=1.79 > MLC1=1.61). However, results did not differ between the groups at the 5% significance level (F=1.85, p=0.17).

Take home message: When only referring to the inferential statistics, conditions did not impact the learners’ performance differently. Nevertheless, enriching worked examples with content-related cues seems to be a promising approach to foster novices’ communication skills. Hence, further investigation is needed.


Zolnierek KB, DiMatteo MR. Physician Communication and Patient Adherence to Treatment. A Meta-Analysis. Med Care. 2009;47(8):826-834. DOI: 10.1097/MLR.0b013e31819a5acc External link
Guttormsen S, Beyeler C, Bonvin R, Feller S, Schirlo C, Schnabel K, Schurter T, Berendonk C. The new licencing examination for human medicine: from concept to implementation. Swiss Med Wkly. 2013;143:w13897. DOI: 10.4414/smw.2013.13897 External link
Frohmel A, Burger W, Ortwein H. Einbindung von Simulationspatienten in das Studium der Humanmedizin in Deutschland. [Integration of simulated patients into the study of human medicine in Germany]. Dtsch Med Wochenschr. 2007;132(11):549-554. DOI: 10.1055/s-2007-970375 External link
Atkinson RK, Derry SJ, Renkl A, Wortham D. Learning from examples: Instructional principles from the worked examples research. Rev Educ Res. 2000;70(2):181-214. DOI: 10.3102/00346543070002181 External link