Validation of the Korean version of the Reflective Practice Questionnaire in clinical clerkship of Korean medical students / 한국의학교육

Purpose@#This study aims to verify whether the Reflective Practice Questionnaire (RPQ) developed by Priddis and Rogers is valid in the Korean context to identify the level of reflection of medical students in clinical practice. @*Methods@#A total of 202 third- and fourth-year medical students from seven universities participated in the study. After receiving approval for use from the authors, a survey was conducted on the students through an adaptation process. The original scale consists of 10 factors with 40 items. The Self-efficacy in Clinical Performance Scale (SECP), Korean Self-reflection and Insight Scale (K-SRIS), and Reflection-in-Learning Scale (RinLS) were used to validate the scale. Exploratory factor, confirmatory factor, correlation, and reliability analyses were used for data analysis. @*Results@#As a result of exploratory factor analysis, 10 subfactors were extracted (Kaiser-Meyer-Olkin=0.856, Bartlett’s test: χ 2 =5,044.337, degrees of freedom=780, p<0.001). Among the 40 items, one that showed a high overlapping load for other factors was excluded. As a result of confirmatory factor analysis, the 10-factor structure model was found suitable (χ 2 =1.980, comparative fit index=0.859, Tucker-Lewis index=0.841, root mean square error of approximation=0.070). As a result of the criterion validity test, most of the subfactors of the Korean version of the RPQ (K-RPQ) showed a positive correlation with K-SRIS, RinLS, and SECP. The reliability of 10 subfactors was satisfactory, ranging from 0.666 to 0.919. @*Conclusion@#The K-RPQ was confirmed to be a reliable and valid tool to evaluate the level of reflection among Korean medical students in clinical clerkship. This scale can be used as a tool to provide feedback on each student’s level of reflection in clinical clerkship.

Psychosocial changes in Medical Students Before and After COVID-19 Social Distancing / 의료커뮤니케이션

Purpose@#: The COVID-19 pandemic has had a far-reaching impact on society. Understanding the changes perceived by medical students is meaningful in that it can suggest the direction of future changes in medical education. The purpose of this study is to investigate the impact of COVID-19 social distancing on psychosocial changes in medical students. @*Methods@#: Anxiety and depression caused by COVID-19, changes in fatigue caused by social distancing, areas where significant changes occurred, and changes in social activity participation and media use behavior among medical students who have experienced the COVID-19 pandemic for more than two years by an online survey. Two hundred twenty-one who are 1st and 2nd-year medical students responded, and we analyzed the results by frequency analysis, independent t-test, paired-sample t-test, and ANOVA. Also, we analyzed Post hoc tests with Tamhane T2, which does not assume equal variance. @*Results@#: The second year of medical school showed higher anxiety and depression than the first. The students who experienced COVID-19 showed lower anxiety, and the more severe the degree of corona blue experience, the higher the anxiety and depression. And the fatigue felt by medical students is higher now than during COVID-19. Areas where the changes due to COVID-19 were seen a lot, were lifestyle attitudes, learning methods, and human relationships. And also, social activities and media medical students use increased after social distancing. @*Conclusion@#: Before and After COVID-19 Social Distancing, medical students have experienced many psychosocial changes.

Research Trends on Doctor’s Job Competencies in Korea Using Text Network Analysis / 의학교육논단

We use the concept of the “doctor’s role” as a guideline for developing medical education programs for medical students, residents, and doctors. Therefore, we should regularly reflect on the times and social needs to develop a clear sense of that role. The objective of the present study was to understand the knowledge structure related to doctor’s job competencies in Korea. We analyzed research trends related to doctor’s job competencies in Korea Citation Index journals using text network analysis through an integrative approach focusing on identifying social issues. We finally selected 1,354 research papers related to doctor’s job competencies from 2011 to 2020, and we analyzed 2,627 words through data pre-processing with the NetMiner ver. 4.2 program (Cyram Inc., Seongnam, Korea). We conducted keyword centrality analysis, topic modeling, frequency analysis, and linear regression analysis using NetMiner ver. 4.2 (Cyram Inc.) and IBM SPSS ver. 23.0 (IBM Corp., Armonk, NY, USA). As a result of the study, words such as “family,” “revision,” and “rejection” appeared frequently. In topic modeling, we extracted five potential topics: “topic 1: Life and death in medical situations,” “topic 2: Medical practice under the Medical Act,” “topic 3: Medical malpractice and litigation,” “topic 4: Medical professionalism,” and “topic 5: Competency development education for medical students.” Although there were no statistically significant changes in the research trends for each topic over time, it is nonetheless known that social changes could affect the demand for doctor’s job competencies.

Psychological characteristics of premedical students in the situation of COVID-19 and educational effect of self reflection meditation / 의료커뮤니케이션

Background@#: In the situation of the national crisis caused by Covid-19, healthcare providers face leadership challenges and professional composure for the benefit of the community. This article aims to find out that self-reflection meditation class for premedical students improves medical leadership and resilience needed for healthcare providers. @*Methods@#: The sample was comprised of 109 premedical students at Pusan National University. We lectured ‘Physicians and leadership’ class focused on self-reflection and meditation for six weeks. We surveyed stress factors, self-reflection, self-esteem, and expectations for life before the class and asked about course satisfaction and changes after the class. A total of 109 questionnaires were retrieved to analyze the data and derive the results of the study. @*Results@#: In the questionnaires about stress factors and self-reflections, grades and exams and questions related to expectations for life recorded the highest average, and negative thinking about self-esteem has the lowest score. In the questionnaire, which asked students to describe their feelings and changes through meditation, most students answered that they could learn to empty negative feelings and be emotionally calm and stable. These were also found in the reflection note analysis. Students experienced ‘self-understanding through deep reflection’ and ‘resolve vague anxiety and fear’ through meditation. This also leads to increase self-awareness and self-satisfaction. @*Conclusion@#: Self-reflection meditation class improved emotional and psychological stability for students and fostered self-leadership to drive their lives in the direction they want. This facilitates interpersonal relationships, leadership, and resilience needed as a healthcare provider.

Assessing the Validity of the Preclinical Objective Structured Clinical Examination Using Messick’s Validity Framework / 의학교육논단

Students must be familiar with clinical skills before starting clinical practice to ensure patients’ safety and enable efficient learning. However, performance is mainly tested in the third or fourth years of medical school, and studies using the validity framework have not been reported in Korea. We analyzed the validity of a performance test conducted among second-year students classified into content, response process, internal structure, relationships with other variables, and consequences according to Messick’s framework.As results of the analysis, content validity was secured by developing cases according to a pre-determined blueprint. The quality of the response process was controlled by training and calibrating raters. The internal structure showed that (1) reliability by generalizability theory was acceptable (coefficients of 0.724 and 0.786, respectively, for day 1 and day 2), and (2) the relevant domains had proper correlations, while the clinical performance examination (CPX) and objective structured clinical examination (OSCE) showed weaker relationships. OSCE/CPX scores were correlated with other variables, especially grade point average and oral structured exam scores. The consequences of this assessment were (1) making students learn clinical skills and study themselves, while causing too much stress for students due to lack of motivation; (2) reminding educators of the need to apply practical teaching methods and to give feedback on the test results; and (3) providing an opportunity for faculty to consider developing support programs. It is necessary to develop the blueprint more precisely according to students’ level and to verify the validity of the response process with statistical methods.

Educational Program Evaluation System in a Medical School / 의학교육논단

A systematic educational program evaluation system for continuous quality improvement in undergraduate medical education is essential. Monitoring and evaluation (M&E) are two distinct but complementary processes referred to in an evaluation system that emphasizes formative purpose. Monitoring involves regular data collection for tracking process and results, while evaluation requires periodic judgment for improvement. We have recently completed implementing an educational evaluation using the M&E concept in a medical school. The evaluation system consists of two loops, one at the lesson/course level and the other at the phase/graduation level. We conducted evaluation activities in four stages: planning, monitoring, evaluation, and improvement. In the planning phase, we clarified the purpose of evaluation, formulated a plan to engage stakeholders, determined evaluation criteria and indicators, and developed an evaluation plan. Next, during the monitoring phase, we developed evaluation instruments and methods and then collected data. In the evaluation phase, we analyzed results and evaluated the criteria of the two loops. Finally, we reviewed the evaluation results with stakeholders to make improvements. We have recognized several problems including excessive burden, lack of expertise, insufficient consideration of stakeholders’ evaluation questions, and inefficient data collection. We need to share the value of evaluation and build a system gradually.

Negative school experiences of Late Millennial Korean medical students: a qualitative study using the critical incident technique / 한국의학교육

Purpose@#Today's students have distinctive generational characteristics and increased psychopathology and generational tension. The authors investigated the negative experiences of Late Millennial students in medical school to draw implications for student support. @*Methods@#The authors explored medical students’ negative experiences using the critical incident technique. The authors conducted semi-structured in-depth interviews with 13 medical students, between February and May 2016. The authors focused on occurrences that significantly influenced medical students’ school lives negatively from the students’ perspective. All interviews were recorded and transcribed. The authors classified incidents into frames of reference for the use of faculty development for student support. @*Results@#The authors extracted 22 themes from a total 334 codes and classified them into eight subcategories. Finally, four categories emerged from frames of reference. Students manipulate relationships and colluding for better specialty choice. They experience uncontrolled rifts in interpersonal relationships between peers including lawsuits, sexual assaults, and social network service conflicts. Today’s students feel resentment towards dependent hierarchical relationships with seniors. They struggle with gender discrimination but perpetuate outdated gender role toward the opposite gender. @*Conclusion@#Faculty members should understand today’s students’ level of career stress and desire for work life balance. They should motivate students’ professional identity, promote assertiveness against unfair authorities, and focus on mental health, teamwork, and relationship building. All generations need to understand other generations and develop appropriate leadership and gender sensitivity.

Perceptions of the interprofessional education of the faculty and the level of interprofessional education competence of the students perceived by the faculty: a comparative study of medicine, nursing, and pharmacy / 한국의학교육

Purpose@#This study will compare differences in perception of interprofessional education (IPE) in the faculty of medicine, nursing, and pharmacy. It will also analyze differences in the level of importance of IPE competences and the present competence levels of their students perceived by the faculty. @*Methods@#The study included 115 participants from the faculty of medicine, 31 from nursing, and 23 from pharmacy. The surveys contained 21 questions on their perceptions of IPE, and perception on the nine competences of IPE. The results were analyzed using analysis of variance and χ2 analysis, and the Borich coefficient was calculated to identify the educational order of priority from the competence levels of their student of IPE. @*Results@#Participants of 14.8% responded that they were aware of IPE, 95.8% responded that they did not have experience in IPE, and 95.8% responded that IPE was necessary. Among the subfactors of perception of IPE, the faculty of medicine had significantly lower perceptions of the importance, effectiveness, and support of IPE (p<0.001). The present competence levels of their students were significantly lower (p<0.001) than the level of importance of IPE competences perceived by the faculty, and its perception was at its lowest in the faculty of medicine. The needs assessment of the IPE program was in the order of communication skills (10.210), conflict-solving skills (10.114), problem-solving skills (9.319), empathy skills (9.110), and collaborative leadership (8.624) among the nine competences. @*Conclusion@#This study will contribute to providing basic data needed to develop faculty development programs on IPE and IPE programs for their students.

How Do Medical Students Prepare for Examinations: Pre-assessment Cognitive and Meta-cognitive Activities / 의학교육논단

Although ‘assessment for learning’ rather than ‘assessment of learning’ has been emphasized recently, student learning before examinations is still unclear. The purpose of this study was to investigate pre-assessment learning activities (PALA) and to find mechanism factors (MF) that influence those activities. Moreover, we compared the PALA and MF of written exams with those of the clinical performance examination/objective structured clinical examination (CPX/OSCE) in third-year (N=121) and fourth-year (N=108) medical students. Through literature review and discussion, questionnaires with a 5-point Likert scale were developed to measure PALA and MF. PALA had the constructs of cognitive and meta-cognitive activities, and MF had sub-components of personal, interpersonal, and environmental factors. Cronbach's α coefficient was used to calculate survey reliability, while the Pearson correlation coefficient and multiple regression analysis were used to investigate the influence of MF on PALA. A paired t-test was applied to compare the PALA and MF of written exams with those of CPX/OSCE in third and fourth year students. The Pearson correlation coefficients between PALA and MF were 0.479 for written exams and 0.508 for CPX/OSCE. MF explained 24.1% of the PALA in written exams and 25.9% of PALA in CPX/OSCE. Both PALA and MF showed significant differences between written exams and CPX/OSCE in third-year students, whereas those in fourth-year students showed no differences. Educators need to consider MFs that influence the PALA to encourage 'assessment for learning'.

Changes of academic performance by integration between basic and clinical medicine in pre-clerkship medical education / 한국의학교육

PURPOSE: The purpose of this study was to investigate the effect of curriculum revision on student performance in tests of the medical knowledge of students at Pusan National University. METHODS: Test scores of the Basic Medicine Comprehensive Examination (BMCE), conducted by the Medical Education Assessment Corporation, and internal clinical knowledge tests of the three integrated courses of the Pusan National University School of Medicine, during the last 3 years (2015–2017) were compared with an unpaired Student t-test and the results were considered to be significant at p < 0.05. RESULTS: Curriculum revision in 2017 introduced the integration of basic and clinical courses at the organ level of medical education. Scores of BMCE and internal clinical knowledge tests in three integrated courses after curriculum revision showed a statistically significant increase after curriculum revision. CONCLUSION: Curriculum revisions that integrated the basic and clinical courses in organ-level education improved student's academic performance significantly.

Factors That Influence Educational Effectiveness and Learning Satisfaction in Biomedical Research Programs during Premedical School / 의학교육논단

Although student research programs have been implemented worldwide, research programs during premedical school have unique characteristics. The purpose of this study is to evaluate factors that influence the effects of premedical school research programs. Eighty second-year premedical students at Pusan National University were included in the study. Effect elements and influential factors were extracted through reference reviews and in-depth individual interviews. A Likert scale questionnaire was developed using the extracted elements and factors, and Cronbach's alpha coefficient was used to analyze the reliability of the survey. The mean value and the standard deviation for each question were calculated to evaluate education effectiveness and learning satisfaction, and the influence of each factor on effect was analyzed using correlation analysis. Students' research skills and knowledge were improved in the short term; however, interest in research or in a career as a researcher did not increase. Student interest, participation, and contributions were important factors. Among professors, passion, considerateness, and teaching method including the level of lesson were influential factors. Implementation of curriculum and support and guidance were influential as well, whereas evaluation system was not a factor. To improve student research programs, several factors that influence education effectiveness and learning satisfaction should be considered.

Relationship of Peer- and Self Assessments in the Anatomy Laboratory and Academic Performance of Gross Anatomy / 체질인류학회지

Gross anatomy, with cadaver laboratory dissection, is in a unique position to preside over a rich number of activities such as the team work, integrity, active learning, communication in the small group-all aspects of professional conduct. The purposes of this study are to investigate the correlation of professionalism with academic performance and the characteristics of groups of students in the performance variables. First-year Pusan National University School of Medicine students (n=108) from the Class of 2015 taking the gross anatomy course were required to do the self- and peer assessment about the professional behaviors of each of the six members of their dissecting group. The students were classified into one of four subgroups based on their deviation from the self- and peer assessment medians, such as high peer/high self (HP/HS), high peer/low self (HP/LS), low peer/high self (LP/HS), low peer/low self (LP/LS). There were significant higher scores in the high peer groups (HP/HS, HP/LS) in comparison with low peer groups (LP/HS, LP/LS) in the academic performance of end-of-term (F=3.24), credit (F=3.54), pre-Lab (F=3.94), practical examination (F=3.60) scores. Significant correlations among academic performance variables were observed generally. There were some differences in the correlation in the practical examination and other variables. The relatively high correlation between practical examination and other variables is HP/HS, followed by LP/LS, LP/HS and then HP/LS. In conclusion, peer- and self assessment subgroups showed a significant differences in the academic performance. This assignment would be available to evaluate work habits of professionalism in the gross anatomy laboratory. It is suggested that HP/HS group was more adaptable in the contextual leaning the gross anatomy course.

The Impact of Alternating Dissection in Conjunction with Reciprocal Peer Teaching on Practical Exam Scores in a Medical Anatomy Course / 체질인류학회지

The reformation of medical curriculum induced the reduction of anatomy course schedule especially in contact hours in anatomy laboratory. It has led to the use of more efficient teaching approaches in anatomy laboratory. The purpose of this work provide a detailed analysis of alternating dissections with reciprocal peer teaching in anatomy laboratory. Students were assigned alphabetically, in teams of eight or nine, to each dissecting table. The team was subdivided into two groups, A and B, each group dissected every other session. Students excused from dissection spent their time with team-based learning and self-directed learning. Dissected peer-teaching groups presented structures from the dissection to groups absent during dissection. Practical exam scores of the alternating dissection indicated no significant difference with those of classical dissection of previous year. Subgroup analysis of practical exam scores in alternating dissection was also no significant difference between group A and B. Assessment of question types showed that correction rates of questions in the dissected region was significantly higher on dissection group assignment. There were 9 questions (out of 86) in which there was a significant difference in correction rates between A and B groups. In conclusion, the laboratory paradigm of alternating dissection with reciprocal peer teaching demonstrated an effective method of learning gross anatomy laboratory for first year medical students.

Structured Assessment to Evaluate a Family Medicine Clerkship Program / 의학교육논단

This correction is being published to revise the acknowledgements of the above article.

Structured Assessment to Evaluate a Family Medicine Clerkship Program / 의학교육논단

This study was conducted to analyze the strengths and weaknesses of a 3-week family medicine clerkship program based on the results of an online survey taken by the students (N=127) and a structured interview with a focus group (n=10), aimed to improve the quality of the clerkship program. The online survey contained questions pertaining to goals, schedule, contents, arrangement, atmosphere, environment, evaluation, and satisfaction regarding the clerkship. The focus group interview addressed the schedule and achievements of the program. Scores were reported on a 5-point Likert scale. Most students were highly satisfied with the overall quality of the clerkship. The structured interview results showed that 97.6% of the clerkship program was executed according to the schedule. The focus group reported a perfect score of 5 points on several measures including: accomplishment of the educational goals of the family medicine clerkship, providing many chances to obtain medical histories and perform physical examinations on real patients, experience with various symptoms and diseases, positive attitudes of faculty members when teaching, notification of the guidelines for evaluation beforehand, well-constructed and effective clerkship schedule, and reflection of student feedback. However, the focus group gave low scores on: support for health accidents of students, access to patient information, enough opportunities to practice clinical skills, appropriate rest facilities for students, and fairness of clerkship evaluation process. In conclusion, the structured evaluation performed after the 3-week clerkship program motivated students and helped them ensure an efficient clerkship. This structured evaluation also suggested basic data to make the professor who is subject of the assessment. This study shows that structured assessment is an effective method which can be used to improve the quality of clerkships.

Research trends in studies of medical students' characteristics: a scoping review / 한국의학교육

The purpose of this study is to investigate domestic and international research trends in studies of medical students' characteristics by using the scoping review methods. This study adopted the scoping review to assess papers on the characteristics of medical students. The procedure of research was carried out according to the five steps of the scoping review. The full texts of 100 papers are obtained and are read closely, after which suitable 88 papers are extracted by us for this research. The review is mapped by the year of the study, source, location, author, research design, research subject, objective, and key results. The frequency is analyzed by using Microsoft Excel and SPSS. We found 70 papers (79.5%) on a single medical school, 15 (17.0%) on multiple medical schools, and three (3.4%) on mixed schools, including medical and nonmedical schools. Sixty-nine (79.5%) were cross-sectional studies and 18 (20.5%) were longitudinal studies. Eighty-two papers (93.2%) adopted questionnaire surveys. We summarized research trends of studies on medical students in Korea and overseas by topic, and mapped them into physical health, mental health, psychological characteristics, cognitive characteristics, social characteristics, and career. This study provides insights into the future directions of research for the characteristics of medical students.

Two-and-a-half year follow-up study of strategy factors in successful learning to predict academic achievements in medical education / 한국의학교육

PURPOSE: We performed a two-and-a-half year follow-up study of strategy factors in successful learning to predict academic achievements in medical education. METHODS: Strategy factors in successful learning were identified using a content analysis of open-ended responses from 30 medical students who were ranked in the top 10 of their class. Core words were selected among their responses in each category and the frequency of the words were counted. Then, a factors survey was conducted among year 2 students, before the second semester. Finally, we performed an analysis to assess the association between the factors score and academic achievement for the same students 2.5 years later. RESULTS: The core words were "planning and execution," "daily reviews" in the study schedule category; "focusing in class" and "taking notes" among class-related category; and "lecture notes," "previous exams or papers," and "textbooks" in the primary self-learning resources category. There were associations between the factors scores for study planning and execution, focusing in class, and taking notes and academic achievement, representing the second year second semester credit score, third year written exam scores and fourth year written and skill exam scores. Study planning was only one independent variable to predict fourth year summative written exam scores. CONCLUSION: In a two-and-a-half year follow-up study, associations were founded between academic achievement and the factors scores for study planning and execution, focusing in class, and taking notes. Study planning as only one independent variable is useful for predicting fourth year summative written exam score.

Effects of Differences in Problem-Based Learning Course Length on Academic Motivation and Self-Directed Learning Readiness in Medical School Students / 한국의학교육

PURPOSE: Problem-based learning (PBL) is an educational approach in which complex authentic problems serve as the context and stimulus for learning. PBL is designed to encourage active participation during learning. The goal of this study was to study the effects of PBL on academic motivation and self-directed learning readiness in medical school students. METHODS: The subjects of this study were 190 students in the 1st and 2nd grade of medical school. The period of the PBL course was two weeks for Year 1 and five weeks for Year 2 students. Students completed one module over one week. Academic motivation tests and self-directed learning readiness tests were performed before and after the PBL course. The differences between the two groups were analyzed using paired t-test and repeated measures MANCOVA. RESULTS: PBL had positive effects on academic self-efficacy (self-control efficacy, task-level preference) and academic failure tolerance (behavior, task-difficulty preference) as academic motivation. PBL had a mildly positive effect on self-directed learning readiness. In addition, the five-week PBL course had greater positive effects on academic motivation than the two-week course but not with regard to self-directed learning readiness. CONCLUSION: Medical students engage in academic motivation and self-directed learning readiness during PBL, suggesting that the five-week PBL course has greater positive effects than the two-week course. Future studies are needed to confirm the most effective periods of PBL.

Differences in Patients' Awareness of Doctors' Communication Styles, Patients' Satisfaction, and Patients' Compliance among Patient Social Styles / 한국의학교육

PURPOSE: It has been well known that doctor-patient communication is a key to the better doctor-patient relationship. However, in Korea, there has not been much researches on the causal factors influencing the doctor-patient communication as well as on patient satisfaction and compliance. This study attempts to investigate the relationships between patient social styles and doctors' communication styles as well as patient outcomes. METHODS: Patient subjects were recruited from two mid-size local hospitals. The questionnaires consist of social styles, patient-perceived doctors' communication, and patient satisfaction/compliance measures. One hundred ninety useable data were analyzed. RESULTS: For those highly satisfied patients, patients with analytic style showed the highest percentage of viewing their doctors as highly empathic. On the other hand, for those patients with high compliance, expressive style patients showed the highest rates of regarding their doctors as highly affective. And amiable style patients are most likely to view their doctors as highly cognitive. For analytic style patients, cognitive empathy had positive effects on patient satisfaction. For amiable style patients, doctors' cognitive empathy had positive influence on patient compliance. For expressive style patients, doctors' affective empathic communication had positive effects on both patient satisfaction/compliance while cognitive had positive effects only on patient compliance. CONCLUSION: The results show that the different social styles of patients might influence on the fact how the patients perceive their doctors' communication as well as how much they are satisfied and compliant. Thus, when we as an medical educators need to realize the importance of this mechanism and bring this learning into classrooms.

Do Personal Characteristics Related to Breaking Bad News Influence Students' Communication Skills? / 한국의학교육

PURPOSE: Delivering bad news is a task that occurs in most medical practices, rendering communication skills essential to competent patient care. The purpose of this study was to identify factors that are associated with scores on an assessment of medical students' communication skills in delivering bad news to help develop more effective curricula to enhance these essential skills. METHODS: One hundred fifty-four fourth-year medical students at Pusan National University were included. Skills for delivering bad news were assessed using the SPIKES protocol in the CPX. The students were categorized into three main groups according to total scores: 'Exceeds expectations (E)', 'Meets expectations (M)', and 'Needs development (N)'. Personal experiences with misfortune and attitudes toward breaking bad news were surveyed, and school records were collected. The differences between the E and N groups were analyzed based on performance test and survey. RESULTS: Compared with students in the N group, E group students acquired significantlyhigher scores on the items of Perception, Invitation, a division of Knowledge, Empathy and Strategy, and Summary but not on Setting and a part of Knowledge. E group students had better records in classes and clerkships. There were no differences in personal experiences and attitudes toward breaking bad news between the groups. CONCLUSION: Personal experience with delivering bad news does not guarantee better communication, and attitudes toward this task do not influence student performance. We expect that deliberate educational programs will have a positive impact on improving communication skills for delivering bad news.