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Guest Author: Megha Shah Fitzpatrick, MD, pediatric intensivist, MGUH Breaking bad news is a core competency in clinical communication and a skill physicians must repeatedly employ throughout their careers. This task carries a significant emotional burden, with clinicians often feeling anxious, fearing negative judgment, worrying about saying the wrong thing, and feeling a strong sense of responsibility for patient outcomes. Despite its importance, fewer than 10% of clinicians say they receive formal training in delivering bad news, and only 32% have regular chances to observe these conversations during training. Lack of preparation may lead to avoiding discussions about prognosis or medical errors, or accidentally conveying unwarranted optimism. These gaps emphasize the need for intentional, continuous, skills-based communication training in undergraduate and graduate medical education. In 2000, Baile et al. introduced the SPIKES protocol, a widely adopted six-step framework (Setting, Perception, Invitation, Knowledge, Empathy, and Summary) to help learners deliver serious news. Since then, this model has evolved into the S-P-w-ICE-S framework, which builds on SPIKES by providing twelve practical strategies for navigating difficult conversations. Links to both references are included below. Additionally, the Vital Talk Tips app offers concise, evidence-based guidance for high-stakes clinical communication, including delivering serious news, facilitating

Authors: Sarah T. Deutsch, MD; Elizabeth Chawla, MD Teaching in the clinical environment, also referred to as “bedside teaching”, centers around education in clinical settings focused on patients and their problems. Becoming an excellent clinical teacher requires professional development, feedback and reflection, and an understanding of learning theories and teaching models. Clinician educators face numerous challenges in implementing effective bedside teaching, including balancing patient care and administrative demands, the unpredictable nature of clinical work, the need to engage learners at multiple levels, a lack of incentives, and time constraints, among others. Here are 12 practical tips to ease teaching challenges in the clinical environment. Preparation: Be familiar with the clinical curriculum and the learners’ needs Planning: What are your teaching goals? How will you engage the learner? How will the content be organized? When will you create time for teaching? Orientation: Understand the learners’ objectives and assign appropriate roles to the team members. Establish “ground rules” for the team. Introduction: Introduce the team to the patients. Orient the patient to the team encounter. Interaction: Be a role model for the physician-patient interaction. This teaches professionalism, humanism, and positive multidisciplinary care partnerships. Observation: Allow the learner to have an active role