Resident Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian NEW YORK, New York, United States
Background: Caring for a dying child requires physician expertise in areas such as communication, symptom management, prognostication, and bereavement; however, many pediatric residents report limited exposure to primary palliative care and express need for formalized educational opportunities. Simulation-based training has been shown to improve both communication skills and clinical competence and is being utilized more frequently within the field of palliative care to augment traditional educational curricula. Objective: The objective of this study is to evaluate the impact of simulation-based medical education on resident comfort with pediatric palliative and end-of-life (EOL) care. Design/Methods: Pediatric residents were invited to participate in an inaugural “Mock No Code” during protected educational conference time in May 2022. The simulation-based workshop included the use of a high-fidelity manikin operated by a technician, with resident leaders playing the roles of a bedside nurse and a family member. Residents who attended the session participated in several 15-minute scenarios involving counseling and communication, symptom management, and eventual death of the simulated patient; scenarios were followed by debriefing discussions led by the pediatric palliative care team with time reserved for questions and formative feedback. Residents were asked to complete pre- and post-session surveys with multiple choice questions using a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree) as well as open-ended questions to evaluate session utility. Results: Of the 11 residents who attended the workshop and completed both surveys, the majority were in their first year of training (n=9, 82%). All participants agreed or strongly agreed that they found the workshop helpful and reported increased perceived comfort in skills including counseling families on expectations for end of life, performing the death exam, and pronouncement. Residents reported that the simulation provided “realistic” and “hands-on” learning in a “safe space,” as well as “great discussion with discrete learning points.” When asked what aspects of their palliative care education in residency they found most helpful, five residents referenced the workshop (n=5, 45%), and the majority of residents requested more simulation-based training (n=7, 64%).
Conclusion(s): Simulation-based medical education can be an effective tool to increase pediatric resident comfort with primary palliative care and should be considered as a constructive addition to both existing and developing palliative medicine educational curricula.
