I'd agree that usually a resident or attending gives the bad news or sits over your shoulder while you do it, but don't be surprised by that moment when it is up to you. I was in my 2nd block of 4th year, and though I had plenty of experience that point delivering results, I'd never been called to deliver bad news. My ED attending was old school, though and had me running the show for less complex patients. He'd look over my shoulder to make sure I didn't screw up, but mostly I just did my thing. I had a guy come in with complaint of flank pain and hematuria, and a very recent diagnosis of diabetes with a new script for onglyza. My ddx going in was kidney stones vs some weird side effect of the new med (unlikely, I know, but I was really positive this was kidneys stones). Since this was a first complaint, I ordered a CT, which was the standard for this ED unless the stones were already known. The read came back as a right kidney mass that was on the upper pole and larger than the kidney, with surrounding lesions suspicious for local spread as well as some possible lesions at the lung base. This was a previously healthy, uninsured guy who never went to the doctor except for physicals for his trucking license, and now he has what is probably a late stage renal carcinoma. I was at a loss, to be honest. I went to my attending, who looked at the CT, agreed, and told me to start the admission. Then, I was to go tell him he was getting admitted and why. I went to the room, and he was sitting in bed with his wife and son in chairs next to him. I told him we had results of the scan and asked if he wanted me to talk with the family in the room. I really was fine with them there, but I wanted to start him thinking that this was serious.