Improving Resident Self-Efficacy in Pediatric Palliative Care Using Clinical Simulation (413-C)

Abstract

1.Discuss resident exposure and comfort with pediatric palliative care.2.Create awareness of importance of clinical simulation in pediatric palliative care and end-of-life discussions.3.Define the impact medical simulation experiences had on pediatric residents and areas of future study. Background. Pediatric residents have limited training and practice experiences with pediatric palliative care during residency. Despite curricula interventions, pediatric residents continue to feel inadequately prepared to provide pediatric palliative care. Medical simulation has become increasingly prevalent in residency education and has been proposed as a method for addressing educational gaps. Research objectives. This study was designed to determine if clinical simulation improved resident self-efficacy in pediatric palliative care. Methods. A survey assessing pediatric resident's self-efficacy and importance of pediatric palliative care issues was given to all (70) residents at a children's hospital at the beginning and end of the 2009–2010. After the initial survey, residents were randomized into a control (n = 40) and an intervention group (n = 30) who participated in two clinical simulated pediatric palliative care scenarios. Likert-scale responses from the surveys were analyzed using ordered logistic regression for all responses observed as well as logistic regression for a dichotomized positive response. Models were used to assess if simulation training impacted residents self-efficacy while controlling for year of residency and repeated measures. Results. Eighty-three percent of residents (N = 58) completed both baseline and follow-up surveys. There were no differences between the simulation and control group on resident perceived importance of pediatric palliative care. Simulation however, did impact resident's self-efficacy with suggestion that a conference is needed (OR 3.64; 95% CI, 1.25, 10.59; p = .015) and explanation of do not resuscitate (DNR)/do not intubate to the family (OR 3.82; 95% CI, 1.12, 13.05; p = .029). Conclusion. Pediatric residents that participated in clinical simulation reported higher comfort recommending palliative care conferences and in the explanation of a DNR order to the family of a child with a life-limiting condition. Implications for research, policy, or practice. Incorporation of simulated end-of-life discussions into residency training could improve outcomes for both families and physicians. Structure and Processes of Care