Effectiveness of Integrating Simulation with Art-Based Teaching Strategies on Oncology Fellows’ Performance Regarding Breaking Bad News

  • Afsaneh Yakhforoshha
  • Seyed Amir Hossein Emami
  • Farhad Shahi
  • Saeed Shahsavari
  • Mohammadali Cheraghi
  • Rita Mojtahedzadeh
  • Behrooz Mahmoodi-Bakhtiari
  • Mandana Shirazi


The task of breaking bad news (BBN) may be improved by incorporating simulation with art-based teaching methods. The aim of the present study was to assess the effect of an integrating simulation with art-based teaching strategies, on fellows’ performance regarding BBN, in Iran. The study was carried out using quasi-experimental methods, interrupted time series. The participants were selected from medical oncology fellows at two teaching hospitals of Tehran University of Medical Sciences (TUMS), Iran. Participants were trained through workshop, followed by engaging participants with different types of art-based teaching methods. In order to assess the effectiveness of the integrating model, fellows’ performance was rated by two independent raters (standardized patients (SPs) and faculty members) using the BBN assessment checklist. This assessment tool measured seven different domains of BBN skill. Segmented regression was used to analyze the results of study. Performance of all oncology fellows (n = 19) was assessed for 228 time points during the study, by rating three time points before and three time points after the intervention by two raters. Based on SP ratings, fellows’ performance scores in post-training showed significant level changes in three domains of BBN checklist (B = 1.126, F = 3.221, G = 2.241; p < 0.05). Similarly, the significant level change in fellows’ score rated by faculty members in post-training was B = 1.091, F = 3.273, G = 1.724; p < 0.05. There was no significant change in trend of fellows’ performance after the intervention. Our results showed that using an integrating simulation with art-based teaching strategies may help oncology fellows to improve their communication skills in different facets of BBN performance. Iranian Registry of Clinical Trials ID: IRCT2016011626039N1


Simulation Education Breaking bad news Interrupted time series 



The authors would like to express their deep gratitude to Dr. Mehrzad Mirzania, Dr. Hazhir Saberi, Dr. Alireza Abdollahi, and Dr. Mohsen Esfandbod for their kind contribution in the study and also would like to thank all the oncology fellows and employers and SPs who participated in this study.

Compliance with Ethical Standards

The study was approved by Ethics Committee at TUMS, and it was registered in the Iranian Registry of Clinical Trials (ID: IRCT2016011626039N1). Informed consent is obtained from fellows and SPs.

Conflict of Interest

The authors declare that they have no conflict of interest.

Supplementary material

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ESM 1 (DOCX 15 kb)


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Copyright information

© American Association for Cancer Education 2018

Authors and Affiliations

  • Afsaneh Yakhforoshha
    • 1
  • Seyed Amir Hossein Emami
    • 2
  • Farhad Shahi
    • 3
  • Saeed Shahsavari
    • 4
  • Mohammadali Cheraghi
    • 5
  • Rita Mojtahedzadeh
    • 6
  • Behrooz Mahmoodi-Bakhtiari
    • 7
  • Mandana Shirazi
    • 8
    • 9
    • 10
  1. 1.Medical SchoolTehran University of Medical SciencesTehranIran
  2. 2.Department of Medical Education, Faculty of MedicineTehran University of Medical SciencesTehranIran
  3. 3.Department of Hematology and Medical Oncology, Cancer Research Center, Cancer Institute, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
  4. 4.School of HealthQazvin University of Medical SciencesQazvinIran
  5. 5.School of Nursing and MidwiferyTehran University of Medical SciencesTehranIran
  6. 6.Virtual SchoolTehran University of Medical SciencesTehranIran
  7. 7.Department of Performing ArtsUniversity of TehranTehranIran
  8. 8.Educational Development Centre (EDC), Faculty of MedicineTehran University of Medical SciencesTehranIran
  9. 9.LIME DepartmentKarolinska InstitutetSolnaSweden
  10. 10.Department of Medical EducationTehran University of Medical SciencesTehranIran

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