Teaching Palliative Care Skills Using Simulated Family Encounters

Publication ID Published Volume
8507 November 2, 2011 7


While there has been a steady increase in awareness of end-of-life issues and palliative care for adults, there continues to be a shortfall in pediatric palliative care education, particularly for physicians in training. This project describes a curriculum intervention developed to train pediatric residents on pediatric palliative care and end of life discussions. Standardized families were trained to portray scenarios from real life experiences. Pediatric residents that participated in the scenarios indicated more comfort and confidence in discussing end of life issues with families. This submission includes the cases and instruments used for the intervention. It is hoped that educators can use the materials to train their residents on end of life issues.

Teaching the skill of delivering bad news and offering palliative care options has been challenging for physicians. Allowing trainees to lead end of life discussions poses a risk of psychological harm to the family, if done poorly. Using a simulated encounter and standardized families to allow trainees to practice these skills was found to be an effective method of resident education. We conducted a study of our first to third year pediatric residents during the 2009-2010 residency year using surveys of self efficacy to compare the differences between residents who received simulator exposure and those who did not. Those residents who completed simulation training had 3.6 times the odds of giving a positive comfort response than those residents who did not complete training when suggesting to a family that an end of life discussion was needed. Simulation trained residents had 3.8 times the odds of giving a positive comfort response than non-simulation trained residents when explaining “Do Not Resuscitate” orders to a family. On exit interviews residents who participated in the simulated encounters reported that the feedback that they received from both the actors and the impartial observers was valuable and would help improve the way they lead family meetings in the future. Simulated end of life discussions have now been incorporated into our institution’s routine Code scenarios and residents will be surveyed annually to evaluate if learned skills are maintained.


Brown C, Gephardt G, Lloyd C, Swearingen C, Boateng B. Teaching palliative care skills using simulated family encounters. MedEdPORTAL Publications. 2011;7:8507. http://doi.org/10.15766/mep_2374-8265.8507

Educational Objectives

  1. To increase resident self-confidence with regard to end of life conversations.
  2. To improve resident communication skills when delivering bad news.
  3. To enhance resident knowledge about available options for patients with terminal diagnoses.


  • Terminal Infant

Prior Scholarly Dissemination


  1. Brown CM, Boateng BA, Lloyd CE, Swearingen CJ. The use of standardized parents in pediatric palliative care. Workshop at the 2011 American Academy of Hospice and Palliative Medicine and the Hospice and Palliative Nurses Association Conference. February 16-19, 2011 at the Vancouver Convention Center in Vancouver, Canada.
  2. Manuscript is in preparation and will be submitted to a journal in the next few months.

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ISSN 2374-8265