MedEdPORTAL (Mar 2013)
Case-Based Simulation: Crucial Conversations Around Resuscitation of the Critically-Ill or Injured Patient
Abstract
Abstract Introduction The majority of in-hospital deaths occur in the emergency department (ED) and critical-care settings. In procedural and resuscitation-based specialties (like emergency medicine and surgery), traditional focus of trainee-education is on acquiring the technical skills associated with advanced cardiac/trauma life-support (ACLS/ATLS). Death is perceived as a professional failure, debriefing is not the norm and self-reflection after these emotionally charged resuscitations rarely addressed. To supplement the technical resuscitation training we designed a structured communication and self-reflection module that adds on skills to effectively communicate with family members of critically ill/injured patients who undergo resuscitations. Methods This case-based simulated-resuscitation session includes the following: (1) a didactic component where trainees discuss and define key elements of closed-loop communication with the interdisciplinary resuscitation team, introduced to the use of self-reflection as a tool for personal growth, and learn an emphasis on family-centered communication skills, (2) a simulated session where trainees practice two scenarios on a simulated-patient: ACLS scenario of cardiac-arrest with resultant patient death; ATLS scenario of massive blunt trauma with a poor and uncertain prognosis, (3) a role play (after resuscitation) by trainees as physicians and family members of the simulated-patient involving the delivery of news of death or poor prognosis to survivors, (4) a learner-completed self-reflection written report, and (5) trainee survey. Peer-observer feedback forms are also provided to be used during the role-play. Results After an oral presentation of the curriculum and related materials at the 2012 American Academy of Hospice and Palliative Medicine National Assembly, 55 attendees evaluated the content of this workshop with an average rated score of 4.56 on a 5-point Likert-like scale; with 1 = lowest and 5 = highest. Comments on the feedback forms included: “Superb session, a real contribution, excellent concept, important topic and love the Trojan horse approach to teaching communication skills.” Further, so many attendees requested access to the material that we ran out of the 75 copies of the content we had on hand and had to resort to emailing the content. Discussion Communication with family members during and after the critical resuscitation of their loved one is often not taught to trainees as an integral part of the resuscitation, especially in procedural specialties like emergency medicine and surgery that often play a huge role in such scenarios. The significance of the work is work is that is specifically addresses this issue.
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