P0480 - The Most Difficult News Training “should be mandatory for all medical students:” A Qualitative Analysis of Medical Student Perspectives on Simulated Death Notification

Background: Notifying a patient’s loved one about their death is a particularly challenging skill that requires specific training.

Objective: We aimed to evaluate fourth year medical student (MS4) perspectives on a formative standardized patient (SP) encounter focused on death notification over the telephone.

Design/

Methods: As part of an MS4 capstone advanced communication skills workshop, an SP case was created for students to practice notification of death over the telephone. Students had preparatory didactics and participated in formative peer feedback and a faculty-led debrief about reactions to the case immediately after the workshop. Debriefing sessions were audio-recorded and transcribed. Students also completed an optional and anonymous post-session survey with free response items. Transcripts and surveys were qualitatively analyzed using content analysis to code responses and extract salient categories and themes.

Results: Five debriefing sessions and 57 post-session surveys about this case were completed for 86 MS4s at one institution. Combined responses from both fell into three general themes: communication challenges, emotional responses, and appreciation for the educational experience. Specific categories related to communication challenges included using language about death, the experience of silence, complications of distance and driving, and communication by phone. Students’ strong emotional reactions were another theme; they described the case as challenging, uncomfortable, intense, and emotional. Despite these strong feelings, students expressed appreciation for the educational experience, specifically noting appropriateness of the preparation and debrief, a sense of safety during the session, and the realistic practice that they gained. Of note, few critiques were made despite requests for ways to improve the case.

Conclusion(s): Death notification training over the phone was a positive experience for MS4s. They reported that the case was appropriately challenging, both in the skills practiced and emotions provoked, but adequate support was in place. Most importantly, many students felt that this case was essential practice and excellent preparation for their future careers. These skills can be included in a formative communication skills curriculum with appropriate attention given to emotional processing. Future investigation of whether death notification training is effective and enduring should be pursued.