{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T17:26:26Z","timestamp":1762363586115,"version":"build-2065373602"},"reference-count":13,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2022,2,7]],"date-time":"2022-02-07T00:00:00Z","timestamp":1644192000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100003579","name":"University of Toronto","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003579","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["asmepublications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Clinical Teacher"],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>High\u2010stakes conversations are frequent in Medical Genetics. News shared is often perceived as \u201cbad\u201d and can lead to patient hostility. Breaking bad news (BBN) is therefore a challenging clinical task for physicians and is often included as a foundational skill in medical education. The methods of teaching this skill are variable, with no widely accepted standard. We propose the use of simulation as a safe and effective training tool.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Approach<\/jats:title>\n                    <jats:p>Medical Genetics residents participated in a 4\u2010week curriculum on BBN and de\u2010escalating patient hostility and anger. The curriculum consisted of (1) a standardised patient simulation scenario requiring the disclosure of abnormal prenatal test result to a hostile patient, (2) coaching and feedback by genetic counsellors (GCs), (3) reflective exercises, and (4) workshops on de\u2010escalation techniques. Trainees completed a postsimulation survey and postencounter reflection forms. Written comments on the survey and the reflections were analysed for themes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Evaluation<\/jats:title>\n                    <jats:p>Six junior and four senior residents participated in this curriculum innovation. Analysis of reflections revealed that simulation coupled with the genetic counsellor's (GC) timely feedback and reflection exercise were good education strategies for practicing BBN and de\u2010escalation techniques in a challenging counselling situation. Most of the trainees felt that this teaching approach was successful and should be used for future training.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications<\/jats:title>\n                    <jats:p>Simulation can help prepare Medical Genetics trainees deliver difficult news and successfully de\u2010escalate a hostile patient encounter. Consideration should be given to counselling and de\u2010escalation simulations as a useful addition to standing curricula for Medical Genetics trainees.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/tct.13466","type":"journal-article","created":{"date-parts":[[2022,2,8]],"date-time":"2022-02-08T01:30:08Z","timestamp":1644283808000},"page":"229-234","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Genetic simulation for high\u2010stakes conversations"],"prefix":"10.1111","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0371-8539","authenticated-orcid":false,"given":"Maha","family":"Saleh","sequence":"first","affiliation":[{"name":"Division of Genetics and Metabolism, Department of Pediatrics University of Western Ontario  London Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Shugar","sequence":"additional","affiliation":[{"name":"Division of Clinical and Metabolic Genetics, Department of Pediatrics University of Toronto  Toronto Ontario Canada"},{"name":"Department of Molecular Genetics University of Toronto  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alison","family":"Dodds","sequence":"additional","affiliation":[{"name":"Learning Institute Hospital for Sick Children  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zia","family":"Bismilla","sequence":"additional","affiliation":[{"name":"Division of Pediatric Medicine, Department of Pediatrics University of Toronto  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,2,7]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajmg.a.36525"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.288.6430.1597"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-010-1620-6"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.167.5.453"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10897-018-0271-3"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/ACM.0000000000003210"},{"issue":"19","key":"e_1_2_8_8_1","first-page":"157","article-title":"Effects on medical students of longitudinal small\u2010group learning about breaking bad news","volume":"24","author":"Moura Villela EF","year":"2020","journal-title":"Perm J"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/ACM.0000000000000938"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2018.11.012"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajmg.a.35952"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/medu.14351"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13353-018-0469-y"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003727-200110000-00004"}],"container-title":["The Clinical Teacher"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/tct.13466","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/tct.13466","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/asmepublications.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/tct.13466","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T17:21:32Z","timestamp":1762363292000},"score":1,"resource":{"primary":{"URL":"https:\/\/asmepublications.onlinelibrary.wiley.com\/doi\/10.1111\/tct.13466"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,7]]},"references-count":13,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2022,6]]}},"alternative-id":["10.1111\/tct.13466"],"URL":"https:\/\/doi.org\/10.1111\/tct.13466","archive":["Portico"],"relation":{},"ISSN":["1743-4971","1743-498X"],"issn-type":[{"type":"print","value":"1743-4971"},{"type":"electronic","value":"1743-498X"}],"subject":[],"published":{"date-parts":[[2022,2,7]]},"assertion":[{"value":"2021-04-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-01-11","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-02-07","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}