Brock Katharine E, Tracewski Meghan, Allen Kristen E, Klick Jeffrey, Petrillo Toni, Hebbar Kiran B
1 Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA, USA.
2 Division of Pediatric Hematology/Oncology, Department of Pediatrics, Emory University, Atlanta, GA, USA.
Am J Hosp Palliat Care. 2019 Sep;36(9):820-830. doi: 10.1177/1049909119839983. Epub 2019 Apr 11.
Pediatric palliative care (PPC) education is lacking in pediatric critical care medicine (PCCM) fellowships, despite the desire of many program directors and fellows to expand difficult conversation training. Simulation-based training is an experiential method for practicing challenging communication skills such as breaking bad news, disclosing medical errors, navigating goals of care, and supporting medical decision-making.
We describe a simulation-based PPC communication series for PCCM fellows, including presimulation session, simulation session, debriefing, and evaluation methods. From 2011 to 2017, 28 PCCM fellows participated in a biannual half-day simulation session. Each session included 3 scenarios (allowing for participation in up to 18 scenarios over 3 years). Standardized patients portrayed the child's mother. PCCM and interprofessional PPC faculty cofacilitated, evaluated, and debriefed the fellows after each scenario. Fellows were evaluated in 4 communication categories (general skills, breaking bad news, goals of care, and resuscitation) using a 3-point scale. A retrospective descriptive analysis was conducted.
One hundred sixteen evaluations were completed for 18 PCCM fellows. Median scores for general communication items, breaking bad news, and goals of care ranged from 2.0 to 3.0 (interquartile range [IQR]: 0-1) with scores for resuscitation lower at 1.0 (IQR: 1.5-2).
This experiential simulation-based PPC communication curriculum taught PCCM fellows valuable palliative communication techniques although revealed growth opportunities within more complex communication tasks. The preparation, methods, and lessons learned for an effective palliative simulation curriculum can be expanded upon by other pediatric training programs, and a more rigorous research program should be added to educational series.
尽管许多项目主任和学员都希望加强困难对话培训，但儿科重症医学（PCCM）专科培训中缺乏儿科姑息治疗（PPC）教育。基于模拟的培训是一种实践具有挑战性的沟通技巧的体验式方法，如告知坏消息、披露医疗差错、明确护理目标以及支持医疗决策。
我们描述了一个针对PCCM学员的基于模拟的PPC沟通系列课程，包括模拟前课程、模拟课程、总结汇报以及评估方法。2011年至2017年期间，28名PCCM学员参加了每半年一次的为期半天的模拟课程。每次课程包含3个场景（3年内最多可参与18个场景）。标准化病人扮演孩子的母亲。PCCM和跨专业PPC教员在每个场景后共同协助、评估并为学员进行总结汇报。使用3分制对学员在4个沟通类别（一般技能、告知坏消息、护理目标以及复苏）进行评估。进行回顾性描述分析。
为18名PCCM学员完成了116次评估。一般沟通项目、告知坏消息以及护理目标的中位数分数在2.0至3.0之间（四分位间距[IQR]：0 - 1），复苏方面的分数较低，为1.0（IQR：1.5 - 2）。
这个基于模拟体验的PPC沟通课程教授了PCCM学员宝贵的姑息治疗沟通技巧，尽管在更复杂的沟通任务中仍显示出成长机会。其他儿科培训项目可以借鉴有效的姑息治疗模拟课程的准备工作、方法以及经验教训，并且应该在教育系列中增加更严格的研究项目。
