Work

Communicating uncertainty with perinatal counseling: a randomized controlled trial of a multimodal curriculum for obstetrical trainees

Year: 2025

Type: article

Study designs: Randomized Controlled Trial, Clinical Trial

Abstract: Background Effective communication of uncertain prognoses is a critical skill in obstetrics. Yet few curricula exist to prepare graduate medical education trainees for these high-stakes conversations. Objective To design and evaluate a multimodal curriculum for improving obstetric trainees' communication skills when conveying uncertain prognoses. Methods In this blinded, randomized controlled trial, obstetrics residents at an academic medical center were assigned to either a standard didactic session or an intervention group receiving a structured, multimodal curriculum. The intervention included a reading assignment on the SPIKES protocol and physician empathy, an instructional video, and facilitated small-group discussion. Two weeks post-intervention, all participants engaged in a standardized patient encounter simulating a periviable diagnosis of preterm prelabor rupture of membranes. Communication performance was assessed using a structured rubric, and stress levels before and after the encounter. Results Twenty-three obstetric trainees completed the study. The intervention group demonstrated significantly higher communication scores (mean score 19.5 vs. 15.5; p=0.02) and greater use of patient-centered techniques such as acknowledging anxiety and minimizing jargon. They also reported lower stress levels during the simulation (mean 3.2 vs. 4.0 on a 5-point scale, p=0.003). Post-intervention surveys revealed improved comfort with delivering complex prognoses and responding to emotional cues. Conclusion This structured SPIKES-based curriculum significantly enhanced obstetric trainees’ communication performance and confidence in simulated counseling scenarios involving uncertain prognoses. The curriculum is feasible for integration into graduate medical education and aligns with ACGME communication competencies. These findings support broader implementation of structured communication training in obstetrics to improve both learner outcomes and patient-centered care.

Source: AJOG Global Reports

DOI: 10.1016/j.xagr.2025.100535

Authors: Melissa Spiel, Eve M. Roth, Allison A. Merz-Herrala, Anna Modest, Brett C. Young

Institutions: Beth Israel Deaconess Medical Center, Harvard University

Language: English

Topic: Patient-Provider Communication in Healthcare

Subfield: General Health Professions

Field: Health Professions

Domain: Health Sciences

SDGs: Good health and well-being, Quality education

Open Access status: gold

Estimated APC paid: $1,980