Teaching Palliative Care to Emergency Medicine Residents Using Gamified Deliberate Practice-Based Simulation. (Preprint)

Abstract

Emergency departments (ED) care for many patients who are chronically ill and nearing end of life. Simulation training offers an opportunity to teach physicians interpersonal skills required to manage end of life care.

We hypothesized a simulation of an imminently dying patient utilizing the LIVE. DIE. REPEAT. (LDR) format would be perceived as an effective method to teach end-of-life communication and palliative care management skills.

This was simulation training replicating the experience of caring for a critically ill patient in the ED. The scenario involved a patient with pancreatic cancer presenting with sepsis and respiratory distress and previously established goal of comfort care. LDR is a serious-game scheme in which learners are allowed infinite opportunities to progress through a single patient scenario. If learners successfully complete the predetermined critical actions, the game is paused and there is a debriefing to reinforce knowledge/skills before progressing to the next stage of the simulation. Conversely, if learners do not achieve critical actions, the game is over, and learners undergo debriefing before repeating the scenario. We used the Simulation Effectiveness Tool – Modified (SET-M) survey to evaluate perceived effectiveness in teaching end-of-life management.

The simulation was divided into four levels and learners were tasked with completing one critical action in each level. Eighty percent of residents completed SET-M survey and nearly 100% either strongly or somewhat agreed that the simulation improved their skills and confidence at the end of life. All residents felt debriefing contributed to learning and provided opportunities to self-reflect. Eighty eight percent strongly agreed they were more confident communicating with the patient and prioritizing care interventions which in the simulation were providing care that aligned with patient’s values.

This palliative simulation using LDR format was perceived by resident physicians to improve confidence in end-of-life communication and palliative care management.