Creation and Assessment of a Bad News Delivery Simulation Curriculum for Pediatric Emergency Medicine Fellows

Abstract

Background Bad news in the context of health care has been broadly defined as significant information that negatively alters people’s perceptions of the present or future. Effectively delivering bad news (DBN) in the setting of the emergency department requires excellent communication skills. Evidence shows that bad news is frequently given inadequately. Studies show that trainees need to devote more time to developing this skill through formalized training. This program’s objectives were to utilize trained standardized patients in a simulation setting to assist pediatric emergency medicine (PEM) fellows in the development of effective, sensitive, and compassionate communication with patients and family members when conveying bad news, and to recognize and respond to the patient/parent’s reaction to such news.MethodsPEM fellows participated in a novel curriculum utilizing simulated patients (SPs) acting as the patient’s parent and immersive techniques in a realistic and supportive environment. A baseline survey was conducted to ascertain participant demographics and previous experience with simulation and DBN. Experienced, multi-disciplinary faculty participated in a training workshop with the SPs one week prior to course delivery. Three scenarios were developed for bad news delivery. Instructors watched via remote video feed while the fellows individually interacted with the SPs and then participated in a confidential debriefing. Fellows later joined for group debriefing. Fellow characteristics, experience, and self-perceived comfort pre/post-course were collected. ResultsBaseline data demonstrated that 78% of fellows reported DBN two or more times per month. Ninety-three percent of fellows in this study were present during the delivery of news about the death of a child to a parent or family member in the six-month period preceding this course. Fellows’ self-reported comfort level in DBN to a patient/family and dealing with patient and parent emotions improved significantly (p=0.034 and p=0.046, respectively).ConclusionsPediatric emergency medicine fellows frequently deliver bad news. A course using SPs was well received by trainees and resulted in improvement in self-assessed skills and comfort. This curriculum provides the opportunity for fellows to receive patient/parent feedback of their communication skills and observations from skilled instructors. This methodology should be considered when creating training curricula for bad news delivery skills.

Efficacy of a Short Role-Play Training on Breaking Bad News in the Emergency Department

“…BBN training in the ED has scarcely been studied to date 32. The studies undertaken have included a limited number of participants,33–34 no validated assessment tools35 or control group,34,35 or were limited to death notification only 21,24. In this study, we assessed the effects of incorporating a four-hour ED BBN simulation-based training (BBNSBT) on self-efficacy, the BBN process, and communication skills among medical students and junior residents who rotated in the ED.…”

The development and implementation of a 12-month simulation-based learning curriculum for pediatric emergency medicine fellows utilizing debriefing with good judgment and rapid cycle deliberate practice

“…Other published curriculums for this learner group are not as thorough as this curriculum. They tend to focus on either a single training gap such as trauma management [51] or delivering challenging news [52], focus on a single piece of the curriculum development process [53], or do not as thoroughly describe their process [51]. As a result, we believe our curriculum is the most generalizable and adaptable curriculum to date.…”

A Simulation-Based Workshop to Improve Dermatologists’ Communication Skills: A Pilot for Continuing Medical Education

“…Examples of OSCE workshops for practicing physicians in the literature are limited. There are few articles that identify the use of OSCEs in training surgical residents and emergency medicine residents, and there are two communication-specific OSCEs among primary care residents [ 7 , 8 , 11 , 17 ]. Among practicing physicians, there are several identified publications that report the use of OSCEs to enhance communication skills [ 10 , 18 – 20 ].…”

“…While effective communication is considered a vital skill, many physicians believe they have inadequate training [ 2 , 7 ]. Physicians struggle with delivering bad news and disclosing medical errors, often using poor methods of communication with their patients [ 8 ].…”