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Background: High‐stakes conversations are frequent in Medical Genetics. News shared is often perceived as "bad" and can lead to patient hostility. Breaking bad news (BBN) is therefore a challenging clinical task for physicians and is often included as a foundational skill in medical education. The methods of teaching this skill are variable, with no widely accepted standard. We propose the use of simulation as a safe and effective training tool. Approach: Medical Genetics residents participated in a 4‐week curriculum on BBN and de‐escalating patient hostility and anger. The curriculum consisted of (1) a standardised patient simulation scenario requiring the disclosure of abnormal prenatal test result to a hostile patient, (2) coaching and feedback by genetic counsellors (GCs), (3) reflective exercises, and (4) workshops on de‐escalation techniques. Trainees completed a postsimulation survey and postencounter reflection forms. Written comments on the survey and the reflections were analysed for themes. Evaluation: Six junior and four senior residents participated in this curriculum innovation. Analysis of reflections revealed that simulation coupled with the genetic counsellor's (GC) timely feedback and reflection exercise were good education strategies for practicing BBN and de‐escalation techniques in a challenging counselling situation. Most of the trainees felt that this teaching approach was successful and should be used for future training. Implications: Simulation can help prepare Medical Genetics trainees deliver difficult news and successfully de‐escalate a hostile patient encounter. Consideration should be given to counselling and de‐escalation simulations as a useful addition to standing curricula for Medical Genetics trainees. [ABSTRACT FROM AUTHOR]

Background: The Royal College of Physicians and Surgeons of Canada (RCPSC) objectives for training in pediatrics include 26 procedural skills, 11 of which are included in the final in-training evaluation report (FITER). The importance of each procedure for practice and the preparedness of pediatric residency graduates to perform these procedures are not known. Methods: A questionnaire was distributed to all pediatric residency program directors and members of the RCPSC Specialty Committee in Pediatrics (N = 21) in October 2010, requesting them to rate the perceived importance and preparedness of graduating pediatric residents in all procedural skills on a 5 point Likert scale, as well as the presence of a curriculum and documentation for each procedure. Mean importance and preparedness were calculated for each procedure. Results: Response rate was 16/21 (76 %). Perceived preparedness was significantly lower than importance for the majority of procedures (p < 0.05). Ten procedures had a high mean importance rating (>3) but a low mean preparedness rating (<3). Presence of a curriculum and documentation for procedures varied across centers, and their presence was correlated with both perceived importance and preparedness (p < 0.0001). Conclusions: Many procedures in which pediatric residents are required to be competent by the RCPSC are felt to be important. Residents are not felt to be adequately prepared in several of the required procedures by the time of graduation. Procedures with high ratings of importance but low preparedness ratings should be targeted for curricular interventions. [ABSTRACT FROM AUTHOR]