RESEARCH Open Access © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Mansoursamaei et al. BMC Medical Education (2023) 23:740 https://doi.org/10.1186/s12909-023-04720-4 BMC Medical Education *Correspondence: Razieh Salehian salehian.r@iums.ac.ir 1 Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, 19857-17443 Tehran, Iran 2 Minimally Invasive Surgery Research Center, Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, 14456-13131 Tehran, Iran 3 Student Research Committee, School of Medicine, Iran University of Medical Sciences, 14456-13131 Tehran, Iran 4 Student Research Committee, School of Medicine, Shahroud University of Medical Science, 36147-73943 Shahroud, Iran 5 Mental Health Research Center, Department of Psychiatry, School of Medicine, Psychosocial Health Research Institute, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, 14456-13131 Tehran, Iran Abstract Introduction Breaking bad news (BBN) is inevitable in medicine and is one of the most important and difcult professional tasks of physicians. The main aims of this study are to evaluate residents’ practice of BBN and identify perceived barriers to its implementation. Methods In this cross-sectional study in 2021, 240 residents from medical, surgical, and emergency medicine departments completed the demographic questionnaire, the Persian SPIKES questionnaire (P-SPIKES), and the researchers-made questionnaire of Barriers to Breaking Bad News (BBBN). In addition, they were asked about their previous experience, previous training, and their perceived level of competence in BBN. Results 46.5% and 36.84% of residents rated their perceived competence in BBN and managing the patient’s emotions during BBN as good or very good, respectively. The most difcult aspects of BBN for residents were expressing upsetting information (78.1%) and not disappointing the patient while being honest (58.3%). The mean and standard deviation of the score of the P- SPIKES was 55.92 ± 6.84. The most common SPIKES item was not giving bad news by phone (98.9%). The SPIKES total score was only related to age (positive relationship). The most commonly reported barriers to BBN were concerns about controlling the patient’s emotions (61%) and the aggressiveness of the patient or companions (52.6%). A signifcant proportion of participants identifed lack of training (28%) and insufcient skills (21.9%) as signifcant barriers to BBN. Conclusions The skill of residents in BBN is insufcient in some aspects and points to the need for BBN training courses during residency. BBN is difcult for residents in some aspects and residents may perceive barriers. To overcome the existing barriers and increase residents’ confdence in BBN, strategies such as incorporating BBN training into residency educational curricula and communication skills are recommended. Keywords Breaking bad news, Giving bad news, Delivering bad news, Physicians, Residents, Barriers Self-assessment of residents in breaking bad news; skills and barriers Maryam Mansoursamaei 1 , Atefeh Ghanbari Jolfaei 2 , Mehdi Zandi 3 , Ali Mansoursamaei 4 and Razieh Salehian 5*