Abstract
BackgroundTo investigate the value of a novel simulation-based palliative care educational intervention within an emergency medicine (EM) residency curriculum.MethodsA palliative care scenario was designed and implemented in the simulation program at an urban academic emergency department (ED) with a 3-year EM residency program. EM residents attended one of eight high-fidelity simulation sessions, in groups of 5–6. A standardized participant portrayed the patient’s family member. One resident from each session managed the scenario while the others observed. A 45-min debriefing session and small group discussion followed the scenario, facilitated by an EM simulation faculty member and a resident investigator. Best practices in palliative care were highlighted along with focused learner performance feedback. Participants completed an anonymous pre/post education intervention survey.ResultsForty of 42 EM residents (95%) participated in the study. Confidence in implementing palliative care skills and perceived importance of palliative care improved after this educational intervention. Specifically, residents 1) felt EM physicians had an important role in palliative care, 2) had increased confidence in the ability to determine patient decision-making capacity, 3) had improved confidence in initiating palliative discussions/treatment, 4) believed palliative education was important in residency, and 5) felt simulation was an effective means to learn palliative care. Differences noted between PGY1 and PGY 3 training levels in survey responses disappeared post-intervention. Residents noted being most comfortable with delivering bad news and symptom management and least comfortable with disease prognostication. Residents reported time constraints and implementation logistics in the ED as the most challenging factors for palliative care initiation.ConclusionOur case-based simulation intervention was associated with an increase in both the perceived importance of ED palliative care and self-reported confidence in implementing palliative care skills. Time constraints and implementation logistics were rated as the most challenging factors for palliative care initiation in the ED.
Highlights
To investigate the value of a novel simulation-based palliative care educational intervention within an emergency medicine (EM) residency curriculum
The specialty of emergency medicine has traditionally focused on resuscitation, stabilization, and management of acute disease processes, with definitive and end-of-life care provided by other medical specialties
Following the intervention, EM residents rated the following statements higher compared with the pre-intervention survey: 1) The role of the emergency medicine physician in palliative care is important (p = 0.0003), 2) I feel confident in my ability to determine a patients decision-making capacity (p = 0.0005), 3) I feel confident with initiating palliative care discussions and treatment in the emergency department (p < 0.0001), 4) Palliative care education is an important component to my residency training (p = 0.0013), and 5) Simulation is an effective educational tool to learn palliative care skills (p < 0.0001) (Table 2)
Summary
To investigate the value of a novel simulation-based palliative care educational intervention within an emergency medicine (EM) residency curriculum. Palliative medicine has been practiced for centuries; only recently has it been formally recognized as a medical subspecialty in the United Sates. The IOM emphasized the importance of effective communication within the field of palliative care and highlighted initiatives to foster competencies within medical curricula [1]. The specialty of emergency medicine has traditionally focused on resuscitation, stabilization, and management of acute disease processes, with definitive and end-of-life care provided by other medical specialties. Some might argue that palliative medicine represents non-emergent interventions; palliative care has many varying definitions. The American Academy of Hospice and Palliative Medicine defines palliative medicine as a means
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call