Surgical residents are often faced with the challenging task of communicating with difficult patients, receiving little formal training. We used standardized patients to assess resident's ability with this task, as well as to evaluate stress levels and insight into their performance.

Twenty-four surgical residents participated in 3 standardized patient (SP) encounters that required them to deliver bad news and deal with angry patients. Residents completed the State-Trait Anxiety Inventory (STAI) before and after difficult SP encounters. The residents and the SPs completed post-session evaluations. Statistical analysis was done with Pearson's correlation as well as T-tests.

Stress levels inversely correlated with performance for senior residents (Pearson −0.56, p=0.04) but correlated positively for junior residents (Pearson 0.49, p=0.15). Junior residents comprised 62% of the overall top third performance, but often underscored their abilities. 80% of juniors scored above average for communication, compared to 50% of seniors. SPs reported that they would follow resident recommendations in 65% of cases (90% juniors and 62% seniors), and 67% would recommend the resident to a friend (90% juniors, 50% seniors). 64% of juniors and 33% of seniors would recommend the exercise to other residents.

High-performing senior residents had low stress and more insight into their abilities, likely because of prior experience with difficult patient scenarios. Conversely, high-performing junior residents were more stressed than their colleagues, possibly asserting more effort. Overall, this was a valuable learning experience in dealing with difficult patient scenarios, likely better suited to junior residents.