Goals of Care Discussion and Withdrawal of Life-Sustaining Treatment Using High Fidelity Simulation (FR426)

Abstract

1.Describe the process of a goals of care discussion and the withdrawal of life-sustaining treatments.2.Demonstrate best practices for creating an educational model for the withdrawal of life-sustaining treatments using high fidelity simulation. Simulation has emerged as a useful educational tool to teach communication skills and medical management of high stakes clinical scenarios. Determining goals of care for patients with critical, immediately life-threatening illnesses is a common conversation many trainees in emergency medicine, internal medicine, critical care, and palliative medicine often have with patients and families. Formal training in how to conduct these conversations as well as training in the implementation of the care plan when it includes removing life-sustaining treatments is lacking in many residency programs. We conducted an internal survey of our training programs and will share this data. We implemented an interdisciplinary training model for house staff in the New York University School of Medicine Emergency Medicine, Internal Medicine, Critical Care, and Palliative Medicine programs to enable physicians to feel more comfortable having these discussions, as well ensure patient and family needs are appropriately met during these complex encounters. A simulated patient with a history of multi-infarct dementia and a new massive cerebral hemorrhage is presented for management to the house staff. The patient has been intubated. The house staff have two tasks evaluated with this simulation exercise. First, trainees are scored using a checklist to assess their competency in the goals of care discussion with the surrogate decision maker (an actor). The decision is made to withdraw the ventilator. The trainees are then scored on a checklist focusing on proper symptom management, ventilator management, and managing family expectations preceding and during the withdrawal of mechanical ventilation from the high fidelity simulated patient. A debriefing session after the two part simulation is facilitated by expert faculty to review expected skill sets and the simulated patient experience. Trainees complete surveys both pre and post simulation. We will present data from those surveys that include attitudes, learners' reactions, and acquisition of knowledge.