Telling families their loved one has died or admitting a medical error isn’t an easy conversation. But students at the Oregon Health & Science University (OHSU) will now have to be tested on it in a first-ever requirement for any medical school.

Kaiser Health News reports the requirement has been advocated by Susan Tolle, MD, director for OHSU’s Center for Ethics in Health Care. She said she’s seen physicians avoid eye contact, resort to medical jargon or generally lack basic compassion when dealing with patients and their families. In one example, she said she’s heard physicians say something like, “You need to call a funeral home.”

“My generation of faculty were not taught,” she said. “I had history-taking, but it was more about, ‘How long have you had chest pain?’ I did not have [instruction in] how to give bad news.’”

The new lessons and standards for communication and ethics focus on conversations like telling a patient they have a serious or even fatal illness. While the Association of American Medical Colleges requires some instruction in communication skills to be accredited, OHSU’s approach is new.

Most OHSU students passed the test, Tolle said, though some will need additional coaching. Common mistakes were failing to introduce themselves properly or ask what families already knew, along with quickly—and bluntly—saying that a patient is dead.

“You watched the screen and it looked like you hit [the spouse] with a truck,” Tolle said. “It comes across as incredibly uncaring.”

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