SIMplifying Palliative Extubations: A Two-Part OSCE in a Simulation Center to Assess Entrustable Professional Activities (EPAs) in Hospice and Palliative Medicine (TH315)

Abstract

•Identify the critical steps of a palliative extubation procedure.•Assess how the Palliative Extubation objective structured clinical exam (OSCE) applies to the clinical competencies of EPAs in Hospice and Palliative Medicine.•Demonstrate the innovative Palliative Extubation OSCE simulation.•Construct an educational toolkit in order to adapt and implement the Palliative Extubation OSCE simulation to your own institution. Healthcare professionals require education and practice to master their communication and procedure skills, especially in potentially distressing circumstances such as palliative extubations. Palliative extubation refers to removal of mechanical ventilator support when, based on an individual's goal of care, it is thought to be prolonging the dying process rather than helping to support through a reversible illness. Removing the endotracheal tube will allow a natural death to occur. In order to provide competent and compassionate care for patients and family members before, during, and after a palliative extubation, healthcare providers must provide a clear explanation of this complex procedure, show proficiency in performing the procedure, and demonstrate leadership skills. One method of evaluating a healthcare provider's competency in the domains of performing a palliative extubation and communication, is through use of an objective structured clinical exam (OSCE). An OSCE in a simulation center is an effective method to teach theoretical knowledge, improve hands-on skills, and assess clinical competencies while also reducing the risk of harm to patients and providers, especially for scenarios that do not occur on a daily basis. A simulation provides the advantage of providing a controlled, standardized situation, allowing for multiple interventions to be applied. This concurrent session describes an innovative Palliative Extubation OSCE in a simulation center using a mannequin as the patient and a standardized patient (SP) actor as a family member. The OSCE is divided into two parts—part 1: the family meeting and part 2: the extubation procedure. This session describes how the OSCE is structured to teach and assess the clinical competencies of the 17 EPAs in Hospice and Palliative Medicine. The session will conclude with a demonstration of the Palliative Extubation OSCE followed by small group discussions on how to implement the OSCE at participants' own institutions.