P0545 - Implementing a pediatric resident curriculum to improve confidence with breaking bad news to patients and their families

Background: The American Academy of Pediatrics advocates for program development in pediatric palliative care (PPC) for all tertiary care centers serving children. Effective and compassionate delivery of bad news is an essential PPC skill relevant to all pediatricians, yet many residency and fellowship programs do not provide dedicated instruction on the subject. Trainees are often expected to develop communication skills independently through observation and trial and error, which can lead to wide variations in skill level.

Objectives: To pilot a curriculum for pediatric residents to improve confidence with delivering bad news, and to determine whether simulation training further improves confidence and clinical skill.

Design/

Method: Participants were second and third year pediatric residents in the pediatric intensive care unit (PICU) of a tertiary care center. At the start of their rotation, residents were given a 1-hour interactive presentation outlining the SPIKES protocol. Developed by Drs. Buckman and Baile, SPIKES is a mnemonic outlining 6 essential steps for delivering bad news. Residents were asked to apply what they had learned by leading a real bad news discussion for one of their patients under the direct supervision of the attending PICU physician. Their performance was evaluated by the attending using a competency assessment tool which looked for skills emphasized by the SPIKES protocol. To assess change in confidence, residents were asked to rate their confidence with various protocol skills both at the start and end of their PICU rotation. To evaluate the additional contribution of simulation to the curriculum, residents were randomized to one of two arms, one with (n=9) and one without (n=7) simulation. In the simulation, residents had to disclose to an actor parent that her child’s cerebral spinal fluid sample had been lost and that a repeat lumbar puncture was advised. Residents each received immediate feedback on their performance from Dr. Kraushaar and were then asked to repeat the simulation incorporating the feedback they received. This study was approved by the institutional review board at the training hospital. Statistics were performed by Dr. Soren Bentzen.

Results: Confidence with delivering bad news increased significantly as a result of the curriculum (p=0.001), and residents who received simulation training trended towards a greater increase in confidence with respect to the control group (p=0.1). Confidence improved the most in residents who were the least confident at the start of their PICU rotation (p=0.002). Preliminary data (n=16) were not able to demonstrate improvement in clinical skill compared to the control group.

Conclusion: The curriculum significantly increased resident confidence with breaking bad news. Participant feedback suggests the curriculum and simulation were meaningful and addressed an unmet educational need. A larger sample size is needed to further clarify the effect of simulation on confidence and clinical skill.