Ventilator Withdrawal in Anticipation of Death: The Simulation Lab as an Educational Tool in Palliative Medicine

Abstract

Simulation is a growing model of education in many medical disciplines. Withdrawal of mechanical ventilation is an important skill set for palliative medicine practitioners who must be facile with a variety of end-of-life scenarios and is well suited to the simulation laboratory. We describe a novel approach using high-fidelity simulation to design a curriculum to teach Hospice & Palliative Medicine fellows the practical aspects of managing a compassionate terminal extubation. This simulation session aims to equip palliative fellows with a knowledge base of respiratory physiology and mechanical ventilation as well as the practical experience of performing a terminal extubation. We designed a three-hour simulation session which includes a one-hour didactic followed by two hours of simulation, with four cases that focus on different teaching points regarding symptom management and practical aspects of removing the endotracheal tube. The session was designed as an annual session for Hospice & Palliative Medicine fellows in our region during a collaborative educational conference. Based on feedback, the session is scheduled for the beginning of the academic year and each fellow is given the opportunity to physically remove the endotracheal tube. Simulation can be effectively used to teach practical and complex bedside skills such as withdrawal of mechanical ventilation to palliative medicine trainees. This method of teaching could be expanded to teach other advanced hospice and palliative care skills.