Clinical learning of nursing students during the COVID-19 pandemic in Limpopo province, South Africa.

BACKGROUND:  The Nursing Education Programme was affected during the coronavirus disease 2019 (COVID-19) pandemic, resulting in nursing students being unable to participate in the clinical experiential learning required by the South African Nursing Council. OBJECTIVES:  The study seeks to explore and describe nursing students' experiences of clinical experiential learning during the COVID-19 pandemic. METHOD:  A qualitative, explorative and descriptive, research design was used in the study. A non-probability purposive sampling method was used, and 55 nursing students participated in the study. Data were collected through six focus group discussions, consisting of 8-12 nursing students in each group. Data were analysed following Tesch's open coding method. RESULTS:  Three themes emerged from the study's findings: The impact of COVID-19 on the clinical experiential learning of nursing students, the effects of COVID-19 on the mental well-being of nursing students, and nursing students' experiences of support during the COVID-19 pandemic. Notably, 11 sub-themes emerged. CONCLUSION:  The findings of this study reveal that the COVID-19 pandemic severely disrupted the Nursing Education Programme, highlighting the challenges of inadequate clinical hours, restricted clinical access and the significant psychological impact on students.Contribution: This study adds to the literature on students' experiences during clinical experiential learning in South Africa during the COVID-19 pandemic.

Collaborative 360° virtual reality training of medical students in clinical examinations.

Simulation-based training in computer-generated environments has always played an important role in clinical medical education. Recently, there has been a growing interest in using 360° videos of real-life situations for training in health professions. Several studies report positive results from using 360° Virtual Reality for individuals, yet there are currently no studies on collaborative 360° Virtual Reality training. In this paper, we evaluate how 360° Virtual Reality can support collaborative training in clinical medical education. The study population consisted of 14 medical students in semester 5 of their Bachelor's programme. The students were divided into three groups before watching and annotating a 360° video of an authentic learning situation inside a collaborative immersive virtual reality space. The original video shows a problem-based examination of the collateral and cruciate ligaments of the knee performed by students under the supervision of a professor. After training in collaborative 360° Virtual Reality, students then had to perform the same tests in a physical examination. The students' performance was subsequently evaluated by a professor with expertise in knee examinations. The results show that 12 out of 14 students received a score of 2 for one or more tests, thereby meeting the required learning objective. One student received a score of 1 and one student did not perform any of the tests. The students actively use the tools provided by the software and different communicative strategies when working collaboratively in 360° Virtual Reality, which enables them to perform the tests in the physical examination by transferring their constructed knowledge. The results indicate that our pedagogical design in collaborative immersive 360° Virtual Reality can become a relevant addition to face-to-face clinical medical training.

Attitude and Perception of Preclinical Undergraduate Medical Students about Problem Based Learning in Medical College of Nepal: A Descriptive Cross-sectional Study.

INTRODUCTION: Problem-based learning is a student-centered learning method. Assessing students' understanding, settled way of thinking and interpretation towards problem-based learning is essential. The objective of the study was to understand the attitude and perception of preclinicalM.B.B.S. students about problem-based learning. METHODS: A descriptive cross-sectional study was conducted from July 5, 2023 to September 4, 2023 for the duration of two months after duly approval from Institutional Review Committee (Protocol No: IRC-LMC-04/Q-23). First and second year M.B.B.S. students who had good experience of attending problem-based learning sessions in integrated basic science subjects were included in the study. Fifteen close-ended questions related to attitude and perceptions were designed in Google Form. The responses were taken on five point Likert scale ranging from strongly disagree (1), disagree (2), neutral (3), agree (4), and strongly agree (5). Data were expressed as frequency and percentage. RESULTS: Among 164 participants, 92 (56.09%) strongly agreed and 67 (40.87%) agreed that problem based learning enhances self-directed learning on the topic. Similarly, 103 (62.80%) strongly agreed and 59 (35.98%) agreed that problem based learning improves communication skills. Likewise, 78(47.57%) agreed and 53 (32.32%) strongly agreed that this learning method improves confidence in decision-making. Moreover, 89 (54.28%) agreed and 58 (35.36%) strongly agreed that tutors motivate students to learn themselves through problem based learning. CONCLUSIONS: Majority of the students have positive attitude and good perception towards problem based learning. This method helps in generating skills like communication skills, group discussion, constructive critical reasoning, decision-making.

An interprofessional postgraduate quality improvement curriculum: results and lessons learned over a 5-year implementation.

PROBLEM: Quality Improvement (QI) is interprofessional by nature; however, most academic QI programs occur in silos and do not leverage the opportunity to bring interprofessional learners together. INTERVENTION: To evaluate QI competencies of physician, nursing, pharmacy, behavioral health, and social work residents after participating in a longitudinal QI curriculum. Lessons learned are shared to guide educators in developing QI curriculum for interprofessional learners. CONTEXT: Cohorts of graduate students over 5 years participated in a QI curriculum that aligned with each professions' core quality competencies. Residents engaged in didactics and experiential learning in primary care clinics. IMPACT: All learners (N = 74) demonstrated improvement in QI knowledge measured by the QIKAT-R and applied their skills demonstrated by completion of a QI project presented at the Institute for Healthcare Improvement annual forums. Participation in QI curriculum resulted in knowledge and skill improvement. LESSONS LEARNED: An experiential QI curriculum is a natural place to bring diverse post-graduate learners together to improve QI knowledge and skills. Successful QI curriculum goals are to (a) align projects with institutional and stakeholder goals, (b) include coaches to promote teamwork and project management, (c) narrow project scope, (d) develop an improvement mindset that failures are learning opportunities, and (e) address needs for data access.

Enhancing medical education for undergraduates: integrating virtual reality and case-based learning for shoulder joint.

BACKGROUND: The integration of Virtual Reality (VR) with Case-Based Learning (CBL) has the potential to revolutionise undergraduate medical education, particularly in complex subjects such as the anatomy and rehabilitation of the shoulder joint. This study aimed to explore the effectiveness of this innovative approach in enhancing learning outcomes and knowledge retention. METHODS: This study employed a parallel-group, assessor-blinded randomised controlled trial (RCT) design. A comprehensive five-week educational programme was developed, combining traditional lecture-based learning with VR-enhanced CBL. The study involved 82 undergraduate students from China Medical University, who were divided into groups receiving different combinations of VR and CBL. Student performance was evaluated through tests and questionnaires. RESULTS: In the anatomy-related courses, the integration of VR technology with CBL yielded significantly higher results (87.71 ± 5.60) compared to traditional methods (82.59 ± 6.64), with a statistically significant difference (P < 0.05). This provides compelling evidence of VR's potential to enhance student engagement and knowledge retention. In the context of physiotherapy-related courses, however, while the test scores of the VR-combined CBL group (81.85 ± 5.99) were marginally higher than those of the traditional CBL group (79.02 ± 7.57), this difference was not statistically significant (P > 0.05). CONCLUSION: The present study provides preliminary evidence for the benefits of incorporating VR into medical education, particularly in anatomy. While the results are promising, further research is needed to explore the optimal integration of VR and CBL in rehabilitation studies and to assess their long-term impact on student learning and clinical performance. TRIAL REGISTRATION: The study was registered with Chinese Clinical Trials Registry (Registration Number: ChiCTR2400089295) on 05/09/2024.

Improving learning experience through implementing standardized team-based learning process in undergraduate medical education.

INTRODUCTION: Team-Based Learning (TBL) is a highly structured active learning methodology shown to have positive learning outcomes in undergraduate medical education (UME). While many medical schools have increasingly adopted TBL, there is considerable variation reported in the literature in the implementation of the standard sequence and key components of TBL. The extent to which this variation affects the benefits of TBL is not well understood. This study aims to assess the impact of implementing the standardized framework of the TBL process on student perception of the benefits of TBL. METHODS: Faculty at our institute were surveyed to determine the frequency of implementation of TBL standards, as described in the literature. Second-year osteopathic medical students (OMS II) were surveyed for their perception of the experience of TBL at the beginning of the academic year. Curricular interventions targeting the enforcement of the standard steps and key components of TBL were implemented in a particular 6-week system course. The students were re-surveyed at the end of the course. Descriptive and thematic analyses were performed on quantitative and qualitative data. RESULTS: Twenty four of 31 (77.4%) faculty participated in the faculty survey, 53 of 105 OMS II students (50.4%) participated in the pre-intervention survey, and 72 of 104 OMS II students (69.2%) participated in the post-intervention survey. Faculty survey results indicated inconsistent implementation of key steps and components of the TBL process. Comparisons of student pre- and post-survey means of the perceived value of various aspects of TBL showed significant improvement in multiple aspects of the TBL process, including readiness assurance tests, immediate feedback, and application activities. Both before and after the intervention, students highly rated the value of teamwork and opportunities for practical application of concepts within TBL. CONCLUSION: While medical students value teamwork in UME and professional development, their perception of TBL can be less than positive if not conducted deliberatively. Assessment of the implementation of the standard TBL steps and components and development of corresponding targeted interventions may improve the TBL experience of medical students. Our process could be generalized to help educators interested in improving TBL in their home institutes.

Assessing the effectiveness of flipped classroom teaching-learning method among undergraduate medical students at gondar university, college of medicine and health sciences: an interventional study.

INTRODUCTION: The flipped classroom teaching-learning method has been increasingly adopted in higher education to enhance student-centered learning. Despite its growing popularity, limited evidence exists regarding its effectiveness in medical education in Ethiopia. This study aimed to assess the impact of the flipped classroom method on academic performance, student engagement, and satisfaction among undergraduate medical students at Gondar University, College of Medicine and Health Science. METHODS: A quasi-experimental study was conducted involving 100 s-year undergraduate medical students, divided into two groups: the flipped classroom group (n = 50) and the traditional lecture-based group (n = 50). The flipped classroom group received online instructional materials before class, while classroom sessions focused on interactive activities. The traditional lecture-based group attended conventional lectures followed by homework assignments. Data were collected using pre- and post-intervention tests to measure academic performance, the Student Engagement Scale to gauge engagement, and a validated questionnaire to assess student satisfaction. Data were analyzed using Statistical Package for the Social Sciences version 25, with descriptive statistics, paired t-tests, independent t-tests, and Chi-square tests employed to interpret the findings. RESULTS: The flipped classroom group demonstrated a significant improvement in academic performance, with mean pre-test and post-test scores of 65.2 ± 8.1 and 78.6 ± 6.9, respectively. In contrast, the traditional lecture-based group had pre-test and post-test mean scores of 62.8 ± 7.5 and 74.2 ± 8.3, respectively. Additionally, the flipped classroom group showed higher levels of student engagement mean scores of 4.5 ± 0.8 and satisfaction mean scores of 4.2 ± 0.7 compared to the traditional lecture-based group, which had engagement mean scores of 3.8 ± 0.6 and satisfaction mean scores of 3.9 ± 0.5. Chi-square tests showed a statistically significant association between the teaching method and both pass/fail rates and participation in activities, but not a significant association with gender distribution. CONCLUSION: The flipped classroom approach proves to be a superior teaching method, promoting better academic outcomes and greater student engagement and satisfaction. This study adds to the growing body of evidence advocating for the implementation of flipped classrooms in medical education. TRIAL REGISTRATION: Not applicable.

The effect of learning styles on the academic achievement of nursing students: a cross-sectional study.

BACKGROUND: Learning in the academic setting is influenced by the dynamic interaction between students and teachers. Recognizing and adapting to diverse learning styles is essential for improving instruction, gaining knowledge, and drawing informed conclusions. Therefore, this study investigated learning styles and their effects on students' academic achievement. METHODS: In a cross-sectional study in Iran's Mazandaran province, 238 nursing students were surveyed between October and December 2021 using random sampling. The questionnaire included socio-demographic data, Kolb's Experiential Learning Model, and students' academic performance (EPT). Statistical analysis with SPSS version 22 involved descriptive statistics, one-way ANOVA, chi-square tests, and linear regression with statistical significance set at p < 0.05. RESULTS: The mean age of the nursing students was 20.95 ± 1.71 years. The most common student learning styles were convergent (75.2%) and accommodator (12.2%). According to the results, convergent (148.62 ± 16.28) and accommodator learning styles (147.72 ± 8.79) with the highest average played a role in students' academic achievement. The mean score of EPT was 147. 13 ± 15.48 (out of 240). A significant difference between the academic performance and different dimensions of learning style was found (p = 0.002). CONCLUSION: Findings indicated that adopting a convergent and accommodator learning style can affect students' academic achievement. Therefore, learning environments appropriate to this style, such as simulation and laboratory activities, are suggested to emphasize practical work and make students think an scrutinize.

"The patient as teacher" - thematic analysis of undergraduate medical students' experiences with an experiential learning project in palliative care.

BACKGROUND: Experiential learning holds high potential for medical students' education in palliative care. At RWTH Aachen University in Germany, medical students can participate in the course "The Patient as Teacher" offering a one-to-one exchange with a terminally ill patient over a period of several weeks complemented with four supervision sessions and writing of a reflective essay. The course had run from 2005 to 2020 before it was paused due to the Covid-19 pandemic. This study aimed to assess the course's value as a palliative care teaching tool by investigating students' motivation and experiences over the years 2005-2020. METHODS: A stratified sample of 24 essays was taken from all submitted essays (n = 78), eight essays from the years 2005-2009, 2010-2014, and 2015-2020. Subsequently, a thematic analysis of the selected essays was conducted. RESULTS: The students felt motivated by the opportunity to gain more experience in palliative care, to improve their communication skills and to decrease insecurities in interaction with terminally ill patients. They learned about the patient's biography and medical history, and encountered physical, psychological, social, and spiritual dimensions of living with a life-limiting disease. Moreover, they experienced relationship building and communication with a terminally ill patient outside their role as future doctors. Ultimately, they considered their participation as a beneficial experience on both a personal and professional level. CONCLUSIONS: The course "The Patient as Teacher" presents a valuable tool for experiential learning in palliative care, which has elicited an unceasingly positive response among the students who participated over the years. It has facilitated medical students in overcoming insecurities in dealing with terminally ill patients and supported them in further developing their professional identity.

The use of the objective structured clinical examination to evaluate paediatric cardiopulmonary resuscitation skills in medical students and measures to improve training.

BACKGROUND: The main objectives of the study were to analyse the use of the Objective Structured Clinical Examination (OSCE) to evaluate the skills of medical students in paediatric basic life support (PBLS), to compare two resuscitation training models and to evaluate the measures to improve the teaching program. METHODS: Comparative, prospective, observation study with intervention in two hospitals, one undergoing a PILS course (Paediatric Immediate Life Support) and another PBLS. The study was performed over three phases. 1º. PBLS OSCE in 2022 three months after the resuscitation training 2. Measures to improve the training program in 2023 3. PBLS OSCE in 2023. Overall results were analysed and comparison between both sites and those for 2022 and 2023 were made. RESULTS: A total of 210 and 182 students took part in the OSCE in 2022 and 2023, respectively. The overall mean score out of 100 was 83.2 (19), 77.8 (19.8) in 2022 and 89.5 (15.9) and 2023, P < 0.001. Overall cardiopulmonary resuscitation (CPR) effectiveness was adequate in 79.4% and 84.6% of students in 2022 and 2023, respectively. The results of hospital students undergoing a PILS course were better (86.4 (16.6) than those undergoing a PBLS. 80.2 (20.6) p < 0.001. The results from both hospitals improved significantly in 2023. CONCLUSIONS: The OSCE is a valid instrument to evaluate PBLS skills in medical students and to compare different training methods and program improvements. Medical students who receive a PILS attain better PBLS skills than those who undergo a PBLS course.

Team-based learning in health professions education: an umbrella review.

BACKGROUND: Team-Based Learning (TBL) has garnered considerable attention in education research. To consolidate the existing evidence, we conducted an umbrella review with four objectives: (a) to identify TBL review characteristics, (b) to synthesize findings from previous reviews regarding TBL effectiveness and outcomes, (c) to determine which student groups benefit most, and (d) to identify the most and least researched elements. METHODS: The Joanna Briggs Institute (JBI) methodology was followed: [1] Search strategy and literature search [2] Screening and Study Selection [3] Assessment of methodological quality [4] Data collection, and [5] Data summary. We utilized Endnote, Excel, and MAXQDA for efficient project management and analyzing data. RESULTS: Analyzing twenty-three reviews spanning from 2013 to 2024, we found a peak in TBL research in 2022 including more than 312 unique primary studies involving more than 63,987 participants. Notably, the United States and China accounted for over 61% of the total primary articles focused on students from medicine, nursing, pharmacy, and dentistry. Evidence supports the superiority of TBL in enhancing cognitive outcomes. However, findings related to retention are mixed. Insufficient evidence exists to draw robust conclusions when comparing TBL with other active learning methods. TBL demonstrates favorable outcomes in terms of clinical performance and engagement. Non-technical skills show mixed results. Notably, TBL positively impacts self-study, learning ability, decision-making, and emotional intelligence. Faculty experiences reveal an initial increase in workload, but generally hold positive attitude. Faculty development remain limited in duration and scope. Freshmen, academically weaker students, undergraduates, Chinese female students, and nursing students appear to benefit most from TBL. Team formation and size are the most frequently studied elements. CONCLUSION: TBL holds promise for improving learning outcomes, but ongoing investigation is essential to maximize its impact in diverse educational contexts. This umbrella review underscores the need for further research in specific areas i.e. effective pre-class learning methods and faculty workload.

The effect of flipped learning on students' basic psychological needs and its association with self-esteem.

BACKGROUND: Modification of the learning environment enhances academic performance, and meta-motivational skills. Yet it is largely unknown which underlying cause potentiates these effects. The study's goal is to analyse flipped classroom (FC) effect on basic psychological needs and self-esteem. METHODS: 40 undergraduate medical students participated in a one-site two phased study. In Phase I, students attended a traditional lecture-based classroom (TC). In Phase II, the same group attended FC. Upon completion of each Phase students completed two questionnaires: Basic Psychological Need Satisfaction and Frustration Scale, and Rosenberg self-esteem scale. RESULTS: Autonomy satisfaction was significantly higher in FC (n = 40, z = 5.520, p < .001), the same tendency was seen for Competence satisfaction in FC (n = 40, z = 5.122, p < .001). As for the frustration of all three needs, the statistical difference was observed for all three subscales between TC and FC. In FC, autonomy (n = 40, z = - 5.370, p < .001), relatedness (n = 40, z = 4.187, p < .001), and competence (n = 40, z = - 5.323, p < .001) frustration was significantly lower. Self-esteem was significantly higher in FC (n = 40, z = 5.528, p < .001). In TC self-esteem negatively correlated with autonomy frustration, (r(38) = - 0.430, p < .01), and competence frustration, (r(38) = - 0.379, p < .05). In FC, self-esteem positively correlated with autonomy satisfaction (r(38) = 0.316, p < .05), and competence satisfaction (r(38) = 0.429, p < .01). CONCLUSIONS: FC better fulfils students' basic psychological needs, specifically needs for autonomy and competence, and self-esteem compared to TC. Collaborative work, and academic scaffolding, contributes to behavioural engagement of students in the learning process. FC with the main focus on students' active involvement may better meet millennials' needs. Implementing validated questionnaires to measure students' psychological needs should become a regular practice in medical schools, specifically during the process of curriculum redesign.

Effectiveness of Metaverse-Based Collaborative Learning in Nursing Education: A Mixed-Methods Study.

BACKGROUND: Collaborative learning is an educational method widely used in nursing education that involves learners solving problems through teamwork. This study investigated the effects of using a metaverse virtual space for collaborative learning among nursing students. METHOD: A nonequivalent control group posttest design was used, and focus group interviews were conducted. This mixed-methods study included second-year nursing students (n = 43) divided into two groups. The intervention group used metaverse methods for the group projects and the control group used traditional methods. RESULTS: Satisfaction with collaborative learning and peer evaluation of team projects were significantly higher in the intervention group compared with the control group. Participants' learning experiences were categorized into "unwelcome changes in the learning environment," "discovering the potential of a learning environment that encourages participation," and "tips for building a metaverse learning environment." CONCLUSION: Metaverse collaborative learning is a student-centered educational approach that fosters active interaction and addresses the shortcomings of traditional approaches. [J Nurs Educ. 2024;63(9):585-593.].

Assessing resident experience of a new experiential learning health advocacy curriculum: a mixed methods study.

BACKGROUND: Health Advocacy is considered one of the most difficult skills to teach. Many medical learners feel ill-equipped in social competencies and identify it as a significant gap in their medical training. Experiential learning has recently been emerging as a more effective method to teach health advocacy. The Post Graduate Medical Education (PGME) Health Advocacy Day is a new experiential learning curriculum designed to teach important competencies of health advocacy and social accountability to post-graduate medical residents at the University of Ottawa in Ottawa, Canada. The objective of this mixed-methods study was to assess resident experiences. METHODS: Second-year trainees from all adult residency programs attended the Advocacy Day as part of a mandatory academic day. All participants completed a mandatory pre-and post-session quiz to assess knowledge of key topics before and after the course. We also distributed a voluntary survey to all participants and invited residents to participate in semi-structured interviews to provide feedback on the course. We used descriptive statistics to analyze quiz scores and survey results and conducted a paired t-test of pre and post-test quiz scores. We also performed a thematic analysis of qualitative feedback, specifically survey comments and semi-structured interviews. RESULTS: One hundred and eighty-three residents participated in the Advocacy Day and 112 (61.2%) completed the post-course survey. Ten residents volunteered to be interviewed. Respondents were generally satisfied by the session and felt it was of good quality. Most residents felt the course enhanced their ability to advocate for individual patients or communities (N = 80; 71.5%) and understand patients and families' lived experience with illness (N = 87; 77.5%). Most residents also felt the course improved their knowledge of the impact of social determinants of health (N = 91; 81.2%) and increased their awareness of local resources that can support patients and their families (N = 88; 78.3%). Visiting community sites in-person and meeting persons with lived experiences were highlighted as the most valuable components of the course. CONCLUSION: Experiential learning can be integrated within post-graduate medical curricula to teach health advocacy competencies. Future studies should examine the longitudinal impact of the curricula, to determine whether shifts in perspectives persist over time.

A combination of case-based learning with flipped classroom improved performance of medical students in nephrology bedside teaching.

BACKGROUND: Bedside teaching remains a challenging endeavor for clinical doctors and medical students, as the students often encounter difficulties in applying their knowledge to clinical situations. This study aims to evaluate the efficacy of combining case-based learning (CBL) with a flipped classroom (FC) approach in nephrology bedside teaching. METHODS: A total of 92 medical students were enrolled in this study, including clerks and interns. The students were assigned into two groups. The CBL/FC group students received the combined teaching approach of CBL and FC (CBL/FC). Students who received the traditional lecture-based teaching (LBT) approach were treated as the control group. General knowledge tests, clinical case scenarios, and questionnaires were used to evaluate the teaching efficacy. RESULTS: Ninety-two students were included in this study. Overall, 46 students were assigned to the CBL/FC group, while the other 46 students were assigned to the LBT group. The students in both groups showed comparable performance in the knowledge test. However, in clinical case scenarios, students in the CBL/FC group demonstrated superior performance compared to those in the LBT group. Additionally, the analysis of questionnaires revealed that the CBL/FC group students expressed more positive attitudes toward their proficiency in medical history taking, physical examination, medical record documentation, clinical reasoning, and consideration for patients' welfare. Moreover, the students from the CBL/FC group regarded the CBL/FC teaching approach as an effective and satisfying method without increasing the learning burden. CONCLUSION: This study reveals that the CBL/FC combined teaching approach shows promise in nephrology education and provides an effective and alternative format for medical teaching.

Breaking bad news: an active learning method for medical students.

BACKGROUND: Breaking bad news is one of the most difficult aspects of communication in medicine. The objective of this study was to assess the relevance of a novel active learning course on breaking bad news for fifth-year students. METHODS: Students were divided into two groups: Group 1, the intervention group, participated in a multidisciplinary formative discussion workshop on breaking bad news with videos, discussions with a pluri-professional team, and concluding with the development of a guide on good practice in breaking bad news through collective intelligence; Group 2, the control group, received no additional training besides conventional university course. The relevance of discussion-group-based active training was assessed in a summative objective structured clinical examination (OSCE) station particularly through the students' communication skills. RESULTS: Thirty-one students were included: 17 in Group 1 and 14 in Group 2. The mean (range) score in the OSCE was significantly higher in Group 1 than in Group 2 (10.49 out of 15 (7; 13) vs. 7.80 (4.75; 12.5), respectively; p = 0.0007). The proportion of students assessed by the evaluator to have received additional training in breaking bad news was 88.2% (15 of the 17) in Group 1 and 21.4% (3 of the 14) in Group 2 (p = 0.001). The intergroup differences in the Rosenberg Self-Esteem Scale and Jefferson Scale of Empathy scores were not significant, and both scores were not correlated with the students' self-assessed score for success in the OSCE. CONCLUSION: Compared to the conventional course, this new active learning method for breaking bad news was associated with a significantly higher score in a summative OSCE. A longer-term validation study is needed to confirm these exploratory data.