Background: End-of-life (EOL) care for a child is a high-stakes situation that requires careful planning and practice; there is only one chance to get it right. Additionally, distress is often high in those caring for dying children. Despite the fact that treating patients with life-threatening illnesses necessitates providing EOL care at some point, formal training and skills practice is not a routine part of pediatric subspecialty training. In contrast, resuscitation - another high-stakes situation - is a skill that is nearly always required for staff. Despite the clear need for good care at EOL, it is generally not recognized that there are distinct EOL skills that need deliberate training and practice. Simulation and skills-based training, similar to that used for resuscitation, can provide opportunities to learn and practice skills in a safe, controlled environment to equip the trainee for the real situation. Purpose: The objective of this study was to evaluate whether a half-day simulation and skills-based workshop was feasible, desirable and could improve perceived confidence of specific EOL skills of pediatric subspecialty fellows. Methods: Hematology-oncology, PICU and NICU fellows at a Midwest academic children’s hospital (n=19) in all years of training were invited to participate in a half-day EOL workshop. Pre-intervention anonymous knowledge and confidence surveys were given to fellows at the beginning of the workshop. The educational intervention consisted of a pre-briefing introduction, 2 immersive simulations done as a team, and an EOL skills station. There was a short debrief after each immersive simulation, and the day concluded with a formal debriefing as a large group. A post-intervention confidence survey was given to fellows at the immediate conclusion of the workshop. Results: All participating fellows (n=17) completed the workshop and surveys. While 82% reported having had ‘a great deal’ of good modeling from attendings on providing EOL care, only 12% reported having had ‘a great deal’ of specific training (i.e. formal teaching or observation) in providing EOL care. Prior to the workshop, 53% of fellows agreed with the statement: “Overall, I feel confident about my ability to provide EOL care to patients.” After the workshop, 88% of fellows agreed or strongly agreed with this statement (Figure 1). For each of the 7 specific EOL care abilities surveyed, fellows’ collective self-reported confidence increased after the workshop, with the exception of the “...ability to address difficult questions (e.g. pain, process of dying, etc.) honestly and compassionately” (Figure 2). Conclusion: Simulation and skills training is an effective and desirable way to teach, practice and integrate skills in EOL care, and can be done in a half-day workshop.
Simulation and Skills Training for Pediatric Fellows: Improving Confidence in High-Stakes Care at End of Life
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Heidi Kamrath, Naomi Goloff, Erik Norbie, Anne Woll; Simulation and Skills Training for Pediatric Fellows: Improving Confidence in High-Stakes Care at End of Life. Pediatrics August 2019; 144 (2_MeetingAbstract): 458. 10.1542/peds.144.2MA5.458
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