Training Pediatric Fellows In Palliative Care: A Comparison Of Simulation-based Training And Didactic Education

Training Pediatric Fellows In Palliative Care: A Comparison Of Simulation-based Training And Didactic Education

Brock K; Cohen H; Sourkes B; Good J; Halamek L

10.1002/pbc.26591

Pediatric Blood And Cancer

2017

Curriculum; Palliative Therapy; Simulation; Cardiology; Child; Clinical Trial; Comfort; Communication Skill; Controlled Clinical Trial; Controlled Study; Family; Female; Hematology; Human; Human Versus Animal Comparison; Male; Medical Education; Neonatology; Nonhuman; Oncology; Physician; Pilot Study; Resuscitation; Single Blind Procedure

Background: Although palliative care (PC) communication skills can be learned through trial and error, pediatric fellows have few opportunities to practice communication, and learning by doing may be harmful for families. Despite these issues and recommendations from professional societies, most fellowship programs either lack formal training or provide only lecture-based PC education. Simulation-based training has been successful in other high-stakes communication encounters, and has the potential to change PC education. Objectives: In this pilot study,we assessed: (1) the relative effectiveness of simulation-based vs didactic education, (2) communication skill retention, and (3) effect on PC consultation rates. Design/Method: Thirty-five pediatric fellows in hematology/oncology, cardiology, critical care, and neonatology at two institutions enrolled: 17 in the simulation-based group (single institution) and 18 in the didactic education group (second institution). Simulation-based subjects participated in a 2-day program over 3 months (three simulations and videotaped PC panel) where scenarios focused on: introducing PC, discussing goals of care and resuscitation preferences, and mediating disagreement between the family and medical team. Didactic-education subjects received written education designed to be similar in content and time. (1) Fellow selfassessments in PC comfort, knowledge, and adequacy of medical education, were measured at baseline, post-intervention and three months; mean between-group differences for each outcome measure were assessed. (2) Two blinded external reviewers rated each simulation-group fellow's encounters on nine communication domains. Within-group changes over time were assessed. (3) The simulation-based site's PC consultation rate was compared in the six months pre- and post-intervention. Results: Compared to the didactic group, subjects in the simulation-based group improved in PC comfort/ self-efficacy (16.4 vs 6.1, DELTA10.3, p = 0.003) and perceived adequacy of medical education (7.4 vs 0.4, DELTA7.1, p<0.001). Both groups had improved PC knowledge; this was not different between groups (1.1 vs 1.8, DELTA-0.7, p = 0.20). Reviewers noted non-sustained improvement in four domains: relationship building (p = 0.01), opening discussion (p = 0.03), gathering information (p = 0.01), and communicating accurate information (p = 0.04). PC consultation rate increased 64%, an improvement when normalized to average daily census (p = 0.04). Simulation-group fellows more strongly agreed that they would use the education in practice (p = 0.04), and recommended that educational methodology (p = 0.004). Conclusion: Well-trained physicians are necessary to providing high quality PC. This simulation-based curriculum is an effective method for improving PC comfort, education, and consults, although it does not lead to sustained improvements in communication competence or knowledge. More frequent, deliberate practice is likely needed to lead to sustained improvements in communication competence.

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October 2017 List