@article{10.22454/FamMed.2026.948308,
author = {Shelesky, Gretchen and Castelli, Gregory and Skef, Suzan and Baker, Dennis and D’Amico, Frank},
title = {ARCH-SPIKES: Faculty Development to Deliver High-Stake, Complex Feedback},
journal = {Family Medicine},
volume = {58},
number = {4},
year = {2026},
month = {4},
pages = {286-292},
doi = {10.22454/FamMed.2026.948308},
abstract = {Background and Objectives: Medical educators often need to give high-stake, bad news, and complex feedback to learners without any formal training about how to do this. This study assessed whether a 60- to 90 minute workshop about the novel model of ARCH (ask, reinforce, correct, help) combined with SPIKES (set up, assess perception, invitation for information, give knowledge, address emotion, strategy and summary) would improve the participant-reported competence and comfort with, knowledge of, and use of ARCH-SPIKES by educators in giving high-stake, bad news, and complex feedback.
Methods: This IRB-approved, prospective survey design study evaluated participant-reported competence and comfort, knowledge, and use of ARCH-SPIKES after a 60- to 90-minute workshop where participants practiced giving high-stake, bad news, and complex feedback in small groups from 2019 to 2022. We collected data pre-workshop, immediately post-workshop, and 6 to 9 months post-post workshop.
Results: In unmatched data analyses, participant-reported competence (from 33% to 69% and then 73%; P<0.01) and participant-reported comfort (from 16% to 54% and then 59%; P<0.01) rose from the pre- to post- and post-post surveys. Knowledge of the ARCH and SPIKES acronyms rose sharply from the pre- to the post-surveys (18% to 98% and 9% to 94%, respectively; P<0.01), and remained significantly improved from baseline (46% for both ARCH and SPIKES; P<0.05). Thirty-six percent of post-post participants used ARCH-SPIKES in the 6 months after the workshop.
Conclusions: This highly interactive workshop increased the participant-reported competence and comfort with, knowledge of, and use of ARCH-SPIKES for giving high-stake, bad news, and complex feedback.},
URL = {https://journals.stfm.org//familymedicine/2026/april/shelesky-0372/},
eprint = {https://journals.stfm.org//media/2fhbrfiy/fammed-58-286.pdf},
}