The Second Conversation project: ­Improving training in end of life care communication among junior doctors

Abstract

Second Conversation was felt to be of most value to newly qualified doctors and worked well on wards where length of stay was longer and EoLC conversations frequently happen. Further evaluation and exploration of patient and caregiver experiences is required.

Recognising the elephant in the room: Foundation doctors and anticipatory care planning

“…It has been suggested that seniors underestimate the fear and apprehension felt by juniors having these conversations, so seniors do not consider routinely inviting juniors to observe them as a valuable learning tool. 2 The Second Conversation intervention promotes embedding supported learning within daily practice and encourages observation, direct experience and reflection. 2 The intervention was found to be effective on longerstay wards with frequent ACP; therefore, the authors acknowledge this may not be transferable to other environments.…”

“…2 The Second Conversation intervention promotes embedding supported learning within daily practice and encourages observation, direct experience and reflection. 2 The intervention was found to be effective on longerstay wards with frequent ACP; therefore, the authors acknowledge this may not be transferable to other environments. Additionally, our study suggests the availability of both informal teaching and observational learning was highly dependent on specialty, which makes adopting a similar workplace-based intervention across the foundation programme problematic.…”

“…These conversations are notoriously challenging for newly-qualified foundation doctors, and a Authors: A final year medical student, University of Leeds, Leeds, UK; B principal teaching fellow, University of Leeds, Leeds, UK; C consultant in elderly medicine, The Leeds Teaching Hospitals NHS Trust, Leeds, UK recent quality improvement project demonstrated clear benefit in a workplace-based training intervention. 2 In this project, foundation doctors observed a senior undertake an initial ACP discussion, then arranged to meet the patient and their family for a second conversation in the days following. This is in keeping with recommendations for best practice in utilising a series of conversations, rather than an isolated discussion, as this allows for clarification.…”

“…3 The reflection following the interaction revealed that junior doctors felt empowered to undertake further ACP with increased competence and greater confidence. 2 The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) form has been nationally adopted to unify and simplify the recording of ACP decision-making discussions across the NHS. 4 The ReSPECT form aims to encourage personcentred care by identifying goals of treatments (palliation or life prolonging focus) and priorities, in the event of an emergency presentation.…”

COVID-19 and ‘conversations not had’ with people with frailty in acute settings

“…8 Models that integrate such training alongside daily clinical practice may be particularly promising. 9 Importantly, these should be supplemented with opportunities for emotional support and reflection to acknowledge and ameliorate the impact of the emotional labour these conversations can involve. 10…”