Rapid‐cycle deliberate practice: death notification

Abstract

Summary Background Death notification can be challenging for emergency medicine physicians, who have no prior established relationship with the patient or their families. The GRIEV_ING death notification curriculum was developed to facilitate the delivery of the bad news of a patient's death and has been shown to improve learners’ confidence and competence in death notification. Rapid‐cycle deliberate practice (RCDP), a facilitator‐guided, within‐event debriefing technique, has demonstrated an improvement in learners’ skills in a safe learning environment. The aim of this study was to identify whether the use of this technique is an effective method of teaching the GRIEV_ING curriculum, as demonstrated by learners’ improved confidence, cognitive knowledge and performance. Methods A 4‐hour pilot curriculum was developed to educate and assess residents on the delivery of death notification. The curriculum consisted of a pre‐intervention evaluation, the intervention phase, and a post‐intervention evaluation. The cognitive test, critical action checklist, and self‐efficacy/confidence surveys were identical for both pre‐ and post‐intervention evaluations. A Wilcoxon rank‐sum test was used to evaluate differences in scores between pre‐ and post‐intervention groups. Results Twenty‐two emergency medicine residents participated in the study. We observed an increase in median self‐efficacy scores (4.0 [4.0–5.0], p ≤ 0.0001), multiple‐choice GRIEV_ING scores (90.0 [80.0–90.0], p ≤ 0.0001) and performance scores for death notification (48.5 [47.0–53.0], p = 0.0303). Discussion The RCDP approach was found to be an effective method to train emergency medicine residents in the delivery of the GRIEV_ING death notification curriculum. This approach is actionable with few resources except for content experts trained in RCDP methodology and the application of the GRIEV_ING mnemonic.

Adaptive change in simulation education: Comparison of effectiveness of a communication skill curriculum on death notification using in‐person methods versus a digital communication platform

“…This approach is optimal for skills with a very scripted or linear approach 9 . We previously applied the RCDP simulation method to GRIEV_ING, 10 a validated death notification tool, to first‐year emergency medicine residents, with significant improvement in knowledge, performance, and confidence 6 …”

“…We used a particular method of medical simulation, rapid cycle deliberate practice (RCDP; (Figure 1), which has been demonstrated to improve residents' clinical performance and skill acquisition in resuscitation and difficult communication. [4][5][6][7] This approach differs from traditional simulation experiences that typically involve the learners completing an entire uninterrupted simulation scenario, followed immediately by debriefing from faculty on their performance.…”

“…9 We previously applied the RCDP simulation method to GRIEV_ING, 10 a validated death notification tool, to first-year emergency medicine residents, with significant improvement in knowledge, performance, and confidence. 6 The DCP delivery of this content was provided to fourth-year medical school students in their final 2 weeks of medical school. This created a natural experiment that allowed us to compare two very different delivery methods, in person and DCP (Zoom), to two very similar learner groups.…”

Rapid Cycle Deliberate Practice in Healthcare Simulation: a Scoping Review

“…This review included 23 studies [ 5 , 9 – 30 ]. Table 1 outlines study characteristics, intervention, comparison, and outcomes.…”

Death notification: a digital communication platform for simulated patient-based training with medical students

“…We modified a well-designed previously studied live simulation programme, the GRIEV_ING educational method, which has been demonstrated to improve death notification skills in emergency medicine interns and paramedics to a digital communication platform. 3 All content was identical to the in-person version; however, learners were remote; separated by hundreds of miles from the simulated patients (SPs), faculty and lecturer. Zoom and email were used to schedule students with the SPs, create the ‘door note’ introducing the student to the patient and the scenario, and record the interactions.…”