Breaking bad news: self-assessment, attitude, and preferences of medical students in GCC countries

Breaking bad news (BBN) is an essential but challenging physician competency. Inadequate preparation for this task is linked to increased stress for both patients and clinicians, as well as poor patient outcomes. This study aimed to assess Gulf Cooperation Council (GCC) medical students’ self-perceived knowledge, confidence, attitudes, and educational preferences toward BBN to identify specific curriculum gaps and inform future training requirements. A cross-sectional analytical study was conducted using a semi-structured online questionnaire distributed to medical students from governmental and private medical schools across six GCC countries. The survey collected data on demographics, BBN knowledge, BBN experiences, self-rated confidence, attitudes, and preferred learning modalities. Data were analyzed using SPSS version 27. Chi-square tests were used to assess associations between categorical variables, and independent sample t-tests were used to compare knowledge levels with mean attitude scores. A total of 365 students participated. While 62.2% demonstrated good theoretical knowledge about BBN, only 38.6% reported confidence in their general ability to perform it. Half of the participants (49.9%) expressed difficulty in showing empathy, and 34.5% were concerned about explaining diagnoses. Only 17.3% had personally delivered bad news. A significant dissociation was found between the type of exposure and its impact: students who witnessed BBN found it educational (73.1%, p < 0.001), whereas those who personally delivered bad news associated the experience with significant stress (68.7%, p < 0.001). Better theoretical knowledge was significantly associated with a more positive attitude (p = 0.003). Participants expressed a strong preference for active, experiential learning, with 47.7% favoring role-playing with simulated patients and 33.2% preferring exercises with a psychologist. This study reveals a marked gap between theoretical knowledge and practical confidence among GCC medical students. While passive observation is perceived as educational, unguided exposure to delivering bad news is associated with heightened stress. GCC medical curricula should incorporate structured, longitudinal training that prioritizes simulation-based practice and reflective debriefing. These interventions are necessary to bridge the gap between knowledge and practice, ensuring students are competent and psychologically prepared for this professional responsibility.