Rakhee Lalla1, Alexandra Dobie2, Stephanie Bissonnette4, Vincent Lau5, Asher Tulsky3, Michelle Kaku6
1University of Massachusetts Memorial Medical Center, 2Palliative Care, 3Internal Medicine, Boston University, 4Boston Medical Center, 5Neurology, Boston University Neurology Department, 6Boston University Neurology Department
Objective:
The purpose of our study is to evaluate if a simulation in neuropalliative care is a useful training method for neurology residents.
Background:
Education in palliative care is lacking in neurology training. The majority of neurology residency programs do not have a formal way to train and assess residents in this domain.
Design/Methods:
The simulation targeted adult and pediatric Neurology residents ranging from PGY2- PGY4. The Serious Illness Conversation Guide (SICG) was used as a framework. Residents first received a didactic reviewing the SICG, followed by two simulations with standardized patients (SPs). The first simulation focused on giving bad news in the outpatient setting. The second focused on shared decision making in the inpatient setting. Residents filled out surveys assessing their comfort levels before and after the simulations, as well as 3 months later to determine how it influenced their practice.
Results:
Twenty-one residents participated in the simulation. Survey responses were received from 100% of participants. After the simulation, respondents who felt comfortable giving bad news increased by 11% for the inpatient setting and by 19% for the outpatient setting. There was a trend towards improved comfort in assessing illness understanding, managing uncertainty in prognosis, making a recommendation based on patient goals, and discussing hospice options. Overall, 91% thought the simulation accurately represented real life and 100% felt that the simulation would influence their future practice. At 3 months after the simulation, 85% of trainees reported using the SICG in palliative care conversations.
Conclusions:
Simulation training with SPs is a valuable way to train neurology residents in neuropalliative care discussions. Future simulations can tailor specific scenarios to resident level of training.