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Simulation-Based Training in Brain Death Determination Incorporating Family Discussion.

ABSTRACT: Background :Good medical care relies on communication as much as technical expertise, yet physicians often overestimate the efficacy of their patient communication skills. Teaching communication skills can be cost- and time-intensive, and efforts have rarely focused on challenging situations, such as conveying the news of a patient's brain death to a family member. Objective :We developed a resource-sensitive simulation program to teach residents how to diagnose brain death and how to show empathy in discussing the diagnosis with the patient's family. Methods :From 2015 to 2017, 3 cohorts of incoming neurology residents participated in the 3-day training exercise. The 2-hour preintervention assessment involved making the diagnosis of brain death and sharing the news with an actor portraying the patient's family member. The scoring via checklists consisted of 15 clinical skills, 9 apnea test-related skills, and 37 verbal skills related to family discussion. The 5-hour didactic intervention focused on technical aspects of the brain death examination and lessons in communication with role-playing. The 2-hour postintervention assessment repeated the brain death examination and family discussion simulations. Data were analyzed using the Wilcoxon signed rank test. Results :A total of 18 residents (100%) were assessed, with significant differences between preintervention and postintervention testing across all areas, including clinical assessment (45%-76%, P < .001), apnea testing (57%-92%, P < .001), and verbal communication (46%-73%, P < .001). Conclusions :The findings suggest a benefit in simulation training for brain death examination, apnea testing, and the subsequent family discussion regarding the patient's diagnosis.

SUBMITTER: Douglas P

PROVIDER: S-EPMC6194878 | biostudies-other | 2018 Oct

REPOSITORIES: biostudies-other

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Simulation-Based Training in Brain Death Determination Incorporating Family Discussion.

Douglas Preston P Goldschmidt Carolyn C McCoyd Matthew M Schneck Michael M

Journal of graduate medical education 20181001 5

<h4>Background</h4>Good medical care relies on communication as much as technical expertise, yet physicians often overestimate the efficacy of their patient communication skills. Teaching communication skills can be cost- and time-intensive, and efforts have rarely focused on challenging situations, such as conveying the news of a patient's brain death to a family member.<h4>Objective</h4>We developed a resource-sensitive simulation program to teach residents how to diagnose brain death and how ...[more]

PMID: 30386482

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Project description:IntroductionEffective team leadership is linked to better teamwork, which in turn is believed to improve patient care. Simulation-based training provides a mechanism to develop effective leadership behaviors. Traditionally, healthcare curricula have included leadership as a small component of broader teamwork training, with very few examples of leadership-focused curricula. The objective of this work is to describe a novel simulation-based team leadership curriculum that easily adapts to individual learners.MethodsWe created a simulation-based team leadership training for trauma team leaders in graduate medical education. Participants included second- and third-year emergency medicine and surgery residents. Training consisted of a single, four-hour session and included facilitated discussion of trauma leadership skills, a brief didactic session integrating leadership behaviors into Advanced Trauma Life Support®, and a series of simulations and debriefing sessions. The simulations contained adaptable components that facilitated individualized learning while delivering set curricular content. A survey evaluation was administered 7-24 months following the training to assess self-reported implementation of trained material.ResultsA total of 36 residents participated in the training and 23 (64%) responded to the survey. The majority of respondents (n = 22, 96%) felt the training was a valuable component of their residency education and all respondents reported ongoing use of at least one behavior learned during the training. The most commonly cited skills for ongoing use included the pre-arrival brief (n = 21, 91%) and prioritization (n = 21, 91%).ConclusionWe delivered a leadership-focused, simulation-based training that 1) adapted to learners' individual needs, and 2) was perceived to impact practice up to 24 months post-training. More work is needed to understand the impact of this training on learner knowledge and behavior, as well as patient outcomes.

Dataset Information

Simulation-Based Training in Brain Death Determination Incorporating Family Discussion.

Publications

Simulation-Based Training in Brain Death Determination Incorporating Family Discussion.

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