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Introduction: Breaking bad news (BBN) in the emergency department (ED) represents a challenging and stressful situation for physicians. Many medical students and residents feel stressed and uncomfortable with such situations because of insufficient training. Our randomized controlled study aimed to assess the efficacy of a four-hour BBN simulation-based training on perceived self-efficacy, the BBN process, and communication skills.Methods: Medical students and residents were randomized into a 160-hour ED clinical rotation without a formal BBN curriculum (control group [CG], n = 31) or a 156-hour ED clinical rotation and a four-hour BBN simulation-based training (training group [TG], n = 37). Both groups were assessed twice: once at the beginning of the rotation (pre-test) and again four weeks later. Assessments included a BBN evaluation via a simulation with two actors playing family members and the completion of a questionnaire on self-efficacy. Two blinded raters assessed the BBN process with the SPIKES (a delivery protocol for delivering bad news) competence form and communication skills with the modified BBN Assessment Schedule.Results: Group-by-time effects adjusted by study year revealed a significant improvement in TG as compared with CG on self-efficacy (P < 0.001), the BBN process (P < 0.001), and communication skills (P < 0.001). TG showed a significant gain regarding the BBN process (+33.3%, P < 0.001). After the training, students with limited clinical experience prior to the rotation showed BBN performance skills equal to that of students in the CG who had greater clinical experience.Conclusion: A short BBN simulation-based training can be added to standard clinical rotations. It has the potential to significantly improve self-efficacy, the BBN process, and communication skills.

Several recent works have highlighted hospital discharge as a good opportunity to deliver patient education (PE). Despite its constraints (overcrowding and unpredictable workload, in particular), the emergency department (ED) should be viewed as an opportune place for improving patient satisfaction and adherence to recommendations, and thus for preventing complications and early readmission, suggesting that better PE and health information could be one way to enhance patient safety. Building evidence on how best to organise and deliver effective PE poses many challenges, however. This paper gives an overview of the main issues (what we already know and prospects for research/clinical approaches) concerning PE in the ED: improving provider skills, ensuring PE continuity, developing educational materials, interprofessional collaboration, identifying specific educational needs for certain subgroups of patients, evaluating PE delivery, and identifying the most effective interventions. Future research will be needed to develop evidence-based guidelines for a comprehensive approach to PE.

Previous studies on the factors that can affect self-esteem and clinical skills during training among bachelor's-level nursing students in Belgium have shown that internships – and evaluation and feedback moments, more specifically – were key points in that process. We did a study to better understand how students experience those moments and which specific aspects of feedback are involved. This article focuses on how feedback is experienced and on the consequences of that in terms of learning. Here we identify the aspects of feedback that can result in positive or negative experiences, with different implications for learning. Our findings highlight the key role that – along with valence – the focus and tone of feedback plays. In addition, students' lived experience can heighten or dampen their motivation to act on feedback and affect how they regulate their learning behavior when feedback is experienced either positively or negatively. Generally speaking, students show resistance or rejection when feedback is experienced negatively. While these results are consistent with other studies, further research is needed to explore the emotional process at work in feedback processing. [ABSTRACT FROM AUTHOR]

Aim: To describe nursing student self‐esteem changes over time and its impacts on learning strategies. Design: Existential phenomenology. Methods: Interviews were conducted in Spring 2018 in a purposive sample of 39 nursing students, exploring events critical to self‐esteem and their impacts. Transcriptions were analysed descriptively and interpretatively to decipher the process that links self‐esteem, events and learning behaviour. Results: What led to self‐esteem changes were "relationships with nurses during internships" and "receiving evaluations." The students interpreted events and drew conclusions about their aptitude for nursing, which in turn prompted proactive or defensive learning behaviours. Their interpretations both depended on their self‐esteem and impacted it, in a vicious or virtuous circle. Exploring self‐esteem allows a better understanding of the importance of students' relationships with nursing teams, and of some of their defensive behaviours. Understanding the role of nursing student self‐esteem in the learning process could help improve student well‐being and competence. [ABSTRACT FROM AUTHOR]

Background Frail elderly people experience elevated mortality. However, no consensus exists on the definition of frailty, and many frailty scores have been developed. The main aim of this study was to compare the association between 35 frailty scores and incident cardiovascular disease (CVD), incident cancer, and all-cause mortality. Also, we aimed to assess whether frailty scores added predictive value to basic and adjusted models for these outcomes. Methods and findings Through a structured literature search, we identified 35 frailty scores that could be calculated at wave 2 of the English Longitudinal Study of Ageing (ELSA), an observational cohort study. We analysed data from 5,294 participants, 44.9% men, aged 60 years and over. We studied the association between each of the scores and the incidence of CVD, cancer, and all-cause mortality during a 7-year follow-up using Cox proportional hazard models at progressive levels of adjustment. We also examined the added predictive performance of each score on top of basic models using Harrell's C statistic. Using age of the participant as a timescale, in sex-adjusted models, hazard ratios (HRs) (95% confidence intervals) for all-cause mortality ranged from 2.4 (95% CI: 1.7-3.3) to 26.2 (95% CI: 15.4-44.5). In further adjusted models including smoking status and alcohol consumption, HR ranged from 2.3 (95% CI: 1.6-3.1) to 20.2 (95% CI: 11.8-34.5). In fully adjusted models including lifestyle and comorbidity, HR ranged from 0.9 (95% CI: 0.5-1.7) to 8.4 (95% CI: 4.9-14.4). HRs for CVD and cancer incidence in sex-adjusted models ranged from 1.2 (95% CI: 0.5-3.2) to 16.5 (95% CI: 7.8-35.0) and from 0.7 (95% CI: 0.4-1.2) to 2.4 (95% CI: 1.0-5.7), respectively. In sex- and age-adjusted models, all frailty scores showed significant added predictive performance for all-cause mortality, increasing the C statistic by up to 3%. None of the scores significantly improved basic prediction models for CVD or cancer. A source of bias could be the differences in mortality follow-up time compared to CVD/cancer, because the existence of informative censoring cannot be excluded. Conclusion There is high variability in the strength of the association between frailty scores and 7-year all-cause mortality, incident CVD, and cancer. With regard to all-cause mortality, some scores give a modest improvement to the predictive ability. Our results show that certain scores clearly outperform others with regard to three important health outcomes in later life. Finally, we think that despite their limitations, the use of frailty scores to identify the elderly population at risk is still a useful measure, and the choice of a frailty score should balance feasibility with performance., Author(s): Gloria A. Aguayo 1,*, Michel T. Vaillant 2, Anne-Françoise Donneau 3, Anna Schritz 2, Saverio Stranges 4, Laurent Malisoux 1, Anna Chioti 1, Michèle Guillaume 3, Majon Muller 5, [...]