27. EFFECTIVENESS OF DELIVERING DIFFICULT NEWS TRAINING: IMPROVED SKILLS AND SELF-EFFICACY OF PEDIATRIC TRAINEES

Abstract

BackgroundDelivering difficult news to patients and families is an essential but challenging communication skill. Pediatric trainees report limited training, competence, or comfort in this skill, and when tested, perform poorly.ObjectiveTo assess the effectiveness of a modified American Academy of Pediatrics (AAP) Resiliency Curriculum (Part B) to improve skills and self-efficacy of pediatric trainees in delivering bad news.MethodsA quantitative research design was used to study the impact of the modified curriculum, offered at one institution with 78 residents and 48 fellows. The course consisted of interactive didactics with faculty role modeling. Fellows also participated in role playing and in novel simulations and self-reflection activities. Self-efficacy surveys were used to assess knowledge, confidence, and comfort with delivering difficult news. Objective performance was assessed during simulations with standardized patients using a bad news delivery framework checklist (“SPIKES”) and the mini Master Interview Rating Scale (mMIRS). Self-efficacy was analyzed using hierarchical mixed effects linear modeling and simulation performance was evaluated using Wilcoxon signed-rank tests.ResultsPediatric trainees (n=67, 29 residents, 38 fellows) improved their scores on each of the 13 self-efficacy items (p=0.007 to <0.001), as well as in the skill categories of displaying empathy (3.8 to 4.0, p=0.016), managing emotions (3 to 3.5, p<0.001), and conversation skills (3.4 to 3.8, p<0.001). For fellows (n=19), objective skill in delivering bad news improved; the median score on the “SPIKES” checklist improved from 78% to 90% completion (p<0.001; Fig. 1) and mMIRS from 4.2 to 4.6 (p<0.001; Fig. 1).ConclusionPediatric residents had significant improvement in self-efficacy and fellows in both self-efficacy and observable skill in delivering difficult news after participation in an AAP modified Resiliency course, with the use of simulation for fellows. These learning activities could serve as a model for other institutions to address gaps in training for difficult news delivery. Delivering difficult news to patients and families is an essential but challenging communication skill. Pediatric trainees report limited training, competence, or comfort in this skill, and when tested, perform poorly. To assess the effectiveness of a modified American Academy of Pediatrics (AAP) Resiliency Curriculum (Part B) to improve skills and self-efficacy of pediatric trainees in delivering bad news. A quantitative research design was used to study the impact of the modified curriculum, offered at one institution with 78 residents and 48 fellows. The course consisted of interactive didactics with faculty role modeling. Fellows also participated in role playing and in novel simulations and self-reflection activities. Self-efficacy surveys were used to assess knowledge, confidence, and comfort with delivering difficult news. Objective performance was assessed during simulations with standardized patients using a bad news delivery framework checklist (“SPIKES”) and the mini Master Interview Rating Scale (mMIRS). Self-efficacy was analyzed using hierarchical mixed effects linear modeling and simulation performance was evaluated using Wilcoxon signed-rank tests. Pediatric trainees (n=67, 29 residents, 38 fellows) improved their scores on each of the 13 self-efficacy items (p=0.007 to <0.001), as well as in the skill categories of displaying empathy (3.8 to 4.0, p=0.016), managing emotions (3 to 3.5, p<0.001), and conversation skills (3.4 to 3.8, p<0.001). For fellows (n=19), objective skill in delivering bad news improved; the median score on the “SPIKES” checklist improved from 78% to 90% completion (p<0.001; Fig. 1) and mMIRS from 4.2 to 4.6 (p<0.001; Fig. 1). Pediatric residents had significant improvement in self-efficacy and fellows in both self-efficacy and observable skill in delivering difficult news after participation in an AAP modified Resiliency course, with the use of simulation for fellows. These learning activities could serve as a model for other institutions to address gaps in training for difficult news delivery.