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

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=.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=.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.