Desenvolvimento do preceptor para o ensino da comunicação de más notícias na residência médica: uma pesquisa-ação

Abstract

Breaking bad news (BBN) is an essential clinical competence in medical practice; however, it remains historically fragmented and poorly systematized within medical residency training. This study aimed to implement a Faculty Development Program for Preceptors (PDDP) focused on teaching BBN and to analyze the training needs and experiences of participating preceptors. This qualitative study adopted an action research design and was conducted at a federal university hospital in Brazil. The research was organized into four stages: diagnostic phase, planning, implementation of the FDPP, and evaluation. Two focus groups were conducted: Focus Group 1 (FG1) during the diagnostic phase and Focus Group 2 (FG2) during the evaluation phase. The intervention consisted of a 20-hour face-to-face course delivered during protected time and involved preceptors from clinical specialty residency programs. FG1 revealed one main category - teaching communication skills - and three secondary categories influencing the teaching and practice of BBN: generational dynamics, mental health, and cultural aspects. The findings indicate that teaching BBN extends beyond technical proficiency, requiring emotional, ethical, and pedagogical competencies. The FDPP was structured using active learning methodologies, including simulation with standardized patients, structured debriefing, team-based learning, and reflective portfolios, integrated with the pedagogical use of an adapted Professionalism Mini-Evaluation Exercise (P-MEX). Preceptors identified recurring challenges, such as difficulty providing formative feedback, the emotional impact of BBN, conflicts related to religious beliefs, and the role of family members in shared decision-making. Analysis of FG2 indicated a positive reaction to the intervention and assimilation of new concepts through reflective learning, fostering the development of communicative and pedagogical competencies and contributing to the initial construction of preceptors’ professional teaching identity, particularly through recognition of their role as communication role models. This study concludes that teaching BBN is not limited to transmitting protocols or scripts but involves sustaining an ethical, humane, and relational stance. Practical implications include the need to institutionalize longitudinal faculty development programs, integrate communication training with mental health support, adopt active methodologies, and strengthen the reflective dimension of faculty education. Study limitations include its single-center design, lack of longitudinal follow-up, and absence of multiprofessional team participation. Future research should explore the validation of national instruments specific to BBN, longitudinal evaluation of educational and clinical impact, and investigations into the interface between BBN, burnout, spirituality, and culture.