Communication competence and behavioral challenges in breaking bad news: a single-center study of Romanian medical residents

BACKGROUND: Breaking bad news (BBN) represents one of the most behaviorally and emotionally demanding communication skills in medical practice, particularly for residents who are still developing their professional and interpersonal competencies. Despite its ethical and psychological complexity, structured communication training remains insufficiently integrated into residency curricula in Romania. METHODS: This cross-sectional, single-center study explored the behavioral preparedness, attitudes, and perceived training needs of Romanian medical residents regarding BBN. A total of 193 residents from multiple specialties at Mureș County Clinical Hospital, Târgu Mureș, completed a self-administered questionnaire assessing their experiences, emotional reactions, perceived barriers, and familiarity with communication protocols such as SPIKES. Participation was voluntary, responses were anonymous, and completion of the questionnaire implied informed consent. RESULTS: Most respondents (94.3%) acknowledged the importance of BBN, yet only 31.6% had practical experience, and 17.6% reported formal training. Awareness and use of structured communication frameworks were limited but correlated with greater confidence and empathy. Experience increased with residency year and varied across specialties. CONCLUSIONS: Romanian medical residents recognize the ethical and emotional significance of breaking bad news but lack structured educational preparation. The findings underline the need for targeted behavioral and educational interventions to strengthen residents’ preparedness, emotional resilience, and patient-centered communication competence. TRIAL REGISTRATION: Not applicable.