Teaching Neurology Trainees to Provide a Terminal Diagnosis Using Objective Structured Clinical Examinations (OCSE)
Mordechai Smith1, Ariane Lewis3, Perrin Pleninger3, Kaitlyn Lillemoe2, Sakinah Sabadia2, Brandon Giglio3, Sondra Zabar4, Elina Zakin4, Arielle Kurzweil2
1Neurology, NYU Langone Health, 2NYU Langone Health, 3NYU Langone Medical Center, 4NYU School of Medicine
To prepare neurology resident to deliver news of a terminal illness through use of simulation. 
Ensuring trainee competency in communication with patients is required by the ACGME. Delivering bad news is a particularly challenging but essential communication skill to master. Various methods are used to teach and assess resident competency on this topic, but the best way to teach this skill, particularly when the neurologic diagnosis is terminal, is unclear.

We developed an objective structured clinical examination (OSCE) in our simulation center that focused on delivering news to a patient about a terminal neuromuscular illness. Third-year neurology residents (N=15) interacted with a standardized professional (SP) playing a patient presenting to discuss the results of his electrodiagnostic study showing evidence of amyotrophic lateral sclerosis. Residents received feedback from faculty observers and the SP regarding their ability to develop a relationship with the patient, communicate bad news effectively, and provide adequate education and counseling. Additionally, residents were surveyed about the value of their experience (scale 1-5, least to most).

A majority of residents completed a post-OSCE questionnaire (N=8, 53%). Most felt unprepared (2.87±0.99), though the majority found the OSCE useful (4.37±0.91). The SP felt that most residents acknowledged feelings and emotions appropriately (91%), provided clear explanations and information (84%), collaborated to plan for next steps (77%), identified an immediate support system (75%), and helped the SP understand the nature of their symptoms (77%).  However, residents less frequently prepared the SP for the news by giving a “warning shot” (64%).
Simulation is a powerful tool that allows residents to learn through an interactive experience, direct observation, and timely feedback.  We have demonstrated the feasibility of utilizing simulation in training residents to deliver a diagnosis of a terminal neurologic illness, and that this method is well received by trainees.