Teaching Palliative Care Skills Using Simulated Family Encounters
|Case, Presentation||8507||1||November 2, 2011|
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.
Brown C, Gephardt G, Lloyd C, Swearingen C, Boateng B. Teaching Palliative Care Skills Using Simulated Family Encounters. MedEdPORTAL; 2011. Available from: www.mededportal.org/publication/8507
- To increase resident self-confidence with regard to end of life conversations.
- To improve resident communication skills when delivering bad news.
- To enhance resident knowledge about available options for patients with terminal diagnoses.
- Terminal Infant
- Interpersonal & Communication Skills
- Medical Knowledge
- Patient Care
- Clinical Sciences
- Clinical Skills/Doctoring
- Communication Skills
- End of Life Care
- Instructional Materials/Methods
- Professional School
- Medical Student
- Professional School Post-Graduate Training
- Standardized Patient
Authors & Co-Authors
Carrie Brown, MD, FAAP
University of Arkansas for Medical Sciences COM
Grace Gephardt, MEd
Arkansas Children's Hospital
Christopher Swearingen, PhD
University of Arkansas for Medical Sciences
Christopher Lloyd, PhD
University of Arkansas at Little Rock
Beatrice Boateng, PhD
University of Arkansas for Medical Sciences
Sponsorship or Funding Source
This work was funded by an intramural CUMG grant from the University of Arkansas for Medical Sciences
Effectiveness and Significance
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.
Special Implementation Guidelines or Requirements
The ability to recruit and train standardized families and video equipment to allow learners to observe and self reflect on their performance, would be ideal. In the absence of SPs and video equipment, hospital staff and an available conference room can be used. However, this may remove the opportunity for residents to observe their performance for self reflection.
Psychosocial support should be available for both actors and trainees as a simulation experience can create a true emotional response for all involved. Care should be taken to limit the number of encounters the actor has in a day/week to minimize emotional distress. We limited our Standardized families to no more than 2 encounters of this nature on any day and not more than three days in any week. Standardized families should also be screened for any previous death experiences of this nature as it could cause an undue emotional burden.
This information is made available under the Creative Commons license.
Publications, Presentations, and/or Citations for this Publication
- 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.
- Manuscript is in preparation and will be submitted to a journal in the next few months.