(Research Abstract Professor Rounds: Group 1) I Am Sorry for Your Loss: Use of Simulation to Train Emergency Medicine Residents to Deliver Death Notifications (1090-003504)
Start time: Tuesday, January 26, 2021, 2:00 PM End time: Tuesday, January 26, 2021, 3:00 PM Session Type: Research Abstracts (Completed Studies)
Emergency medicine (EM) physicians are frequently tasked with delivering death notifications. These interactions are uniquely difficult due to the busy and impersonal emergency department (ED) setting, the sudden and unexpected nature of the deaths, and the lack of established relationships with bereaved survivors. In addition, EM physicians often must perform the death notification shortly after participating in a stressful but ultimately unsuccessful resuscitation of the patient. Simulation has been identified as a potentially useful modality for providing EM trainees with the skills to deliver bad news more effectively (1-4). We developed a simulation-based curriculum for training death notification skills that incorporates many of the unique challenges faced by EM physicians. The purpose of this study was to evaluate the perceived realism of the simulation experience and assess its effect on the confidence of EM residents in performing death notifications.
We designed a death notification simulation scenario and implemented it during our EM residency educational conference. Participants served as team leaders in the resuscitation of a patient (high-fidelity simulator) in cardiac arrest; this resuscitation uniformly ended with the patient’s death. Participants were then notified of the arrival of the patient’s spouse (actor) and were expected to deliver the death notification to this simulated survivor. Participants then engaged in a debriefing of the scenario during which they received structured feedback from EM faculty and an ED social worker. At the end of the session, participants completed anonymous paper surveys in which they rated aspects of the scenario and their pre-course (retrospective) and post-course confidence in performing death notifications on a 5-point Likert scale.
Thirty-nine EM residents participated in the simulation experience. Each resident participated the scenario individually. Ninety-two percent (36/39) of the participants completed the post-course survey. The residents rated the overall educational value of the session as very high (mean 4.92; SD 0.28) and felt the knowledge and skills gained would significantly improve their practice (mean 4.94; SD 0.23). The simulation scenario was rated as highly realistic (mean 4.97; SD 0.17). Compared to pre-course ratings, participants reported statistically significant post-course improvements in their level of confidence in delivering death notifications [mean 3.08 (SD 0.91) vs. mean 4.36 (SD 0.64); P<0.001] and felt they had a more systematic approach to these challenging interactions [mean 3.11 (SD 0.95) vs. mean 4.08 (SD 0.65); P<0.001].
We have developed and successfully implemented a simulation-based curriculum for preparing EM residents to perform death notifications in the ED. Participants felt the experience was highly valuable and found the simulation scenario very realistic. The session increased confidence in delivering death notifications and provided residents with a framework for approaching these difficult conversations. Simulation experiences that incorporate the unique challenges of the ED environment may be particularly beneficial for improving the death notification skills of EM physicians.