175TF Design and Integration of an Emergency Medicine Focused Interpersonal Skills Simulation Curriculum

Abstract

Simulation is one of the most powerful tools for emergency medicine (EM) resident education and training. Standardized patients (SPs) are frequently used to help further create the near-realistic environment, adding to the experiential learning for trainees. Simulation with SPs have also been shown to be an excellent tool, both well-established and well-studied for teaching and evaluating communication skills, an ACGME core competency. To improve training in communication and interpersonal skills, we have created a simulation curriculum with an EM focus, utilizing SPs and cases that go beyond medical management. Upon completion of the Interpersonal Skills Simulation Curriculum participants will: 1) recognize the importance and relevance of having communication skills for all patient and family encounters, 2) demonstrate excellent communication skills and apply learned strategies in all patient care scenarios, and 3) express greater confidence and comfort in challenging patient encounters. The curriculum spans over 4 years. At the start of each academic year, each residency class will have 2 designated cases for each resident to run. Prior to the simulations, residents will fill out pre-evaluations on confidence and comfort levels. Post-evaluations will be done by the SP and an observing attending with immediate feedback given during debrief. Following each debrief, the residents will run through a mirror case to allow for incorporation of feedback received and learned strategies. For example, a pediatric blunt traumatic code requiring the delivery of bad news to highly emotional parents would be mirrored by a case of Sudden Infant Death Syndrome requiring similar delivery of bad news. There would be a graded experience of cases each year, concordant with training level, with cases ranging from delivering bad news, to managing difficult consultants, withholding confidential pediatric patient history from demanding parents, and caring for the transsex patient. Excellent communication skills are absolutely necessary for physicians. Despite the need, a 2018 CORD survey found that EM residents are uncomfortable in several communication scenarios and that training is lacking. At our institution, a survey of graduating residents demonstrated that they felt there was not enough formal education in regards to communication skills, especially in the setting of challenging patient encounters. They also felt particularly less confident in managing difficult pediatric scenarios. This curriculum was piloted amongst a focus group of chief residents and simulation faculty in coordination with our institutional simulation center to assure feasibility of this longitudinal curriculum and will begin over the upcoming years. To our knowledge, no other EM-based, longitudinal simulation curriculum with a focus on interpersonal skills and communication exists. Training in communication is essential and overall appears to be lacking in many EM residencies, including our own institution. After completion of our longitudinal simulation curriculum, residents will be able to display excellent communication skills and feel more confident and comfortable with the variety of challenging patient care scenarios that we face in EM.