1298. Donor Call Simulation: A Novel Medical Education Tool to Evaluate Trainees’ Clinical Decision-Making in Transplant Infectious Disease

Abstract

Background Simulation is a useful education tool for high-stakes clinical skills and decision-making. Recommending whether to accept or reject an organ for transplantation based on infection risk is a critical core competency in Transplant Infectious Disease (ID), however there are no published data that learners have opportunities to practice this during training. We created a novel simulation to expose learners to this real-life clinical scenario and evaluated their clinical decision-making in these situations. Methods We created 6 simulations with common ID consult questions about whether to accept or reject an organ for transplant based on infection risk (Table 1). During learners’ Transplant ID rotations, faculty periodically texted or paged them with the simulation cases as though they were the transplant coordinator. Learners had 15 minutes to ask follow up questions before deciding to accept or reject the organ and explain their decision-making process in a survey. Learners completed a survey 1 month after the simulation experience to evaluate its effectiveness. Results Between October 2021 and April 2022, 16 learners from 7 medical centers participated in the simulation (Table 2) and 94% (15/16) completed the follow up survey. Eighty-seven percent (13/15) of ID learners reported that the simulation was effective in teaching them when to accept or reject organs and 80% (12/15) felt more prepared to make these decisions in practice. Most learners correctly identified acceptable organs for transplant during the simulations (Figure 1). Of the 100 clinical reasoning decisions made during the activity, 19% were discordant, where the learner correctly decided to accept or decline the organ but with incorrect or incomplete reasoning for this decision (Figure 2). Conclusion ID learners perceived our transplant ID simulation as an effective educational tool to learn when to accept or reject an organ for transplant. By evaluating the clinical reasoning behind these decisions our simulation provides ID educators with nuanced insight into their learners' thought process and allows for targeted coaching to correct deficits in reasoning. Disclosures Rebecca Kumar, MD, Gilead: Grant/Research Support|Regeneron: Grant/Research Support Jonathan Hand, MD, GlaxoSmithKline: Grant/Research Support|Janssen: Grant/Research Support|Pfizer: Grant/Research Support Roderick Go, DO, Aptose Biosciences: Stocks/Bonds|Bristol Meyers Squibb: Stocks/Bonds|Cytodyn Inc.: Stocks/Bonds|Scynexis: Grant/Research Support Erica J. Stohs, MD, MPH, bioMerieux: Grant/Research Support.

The nuts and bolts of transplant infectious disease training

“…There were several participants in the #TxIDChat who mentioned the need to include formal teaching about strategies on how to handle TID‐related donor calls 16 . Several programs reported using donor call simulations with real‐world, common scenarios in which transplant teams ask for TID assistance regarding the decision of whether to accept an organ and, if so, how to treat and manage the recipient 17 . Such simulations can help to ensure that TID fellows are well‐versed in how to handle the calls, as fellows are not always involved in these discussions, which tend to be attending‐to‐attending calls.…”

A review of transplant infectious diseases and pediatric transplant infectious diseases curriculum

“…This includes practice-based learning wherein they become familiar with and utilize guidelines and evidence-based medicine resources in decision making, professionalism and communication with patients, families, surgical colleagues, and multidisciplinary teams, ethics as they relate to the processes of organ transplantation and utilization, and systems development including the structure and function of national and regional transplant organizations [20 ▪▪ ]. A recent preliminary study investigated the implementation and evaluation of case-based simulations of ‘donor calls’ targeted towards ID trainees [30 ▪ ]. Six simulations were texted or paged to the trainees, and the trainees had 15 min to reply to the message to either accept or decline the organ offer.…”

“They paged me what?”: A transplant infectious disease guide to donor calls

“…Many fellows do not have exposure to such calls during their training, and while there are simulations to introduce trainees to the process of donor calls, 2 these are not used broadly. Having a principled framework to handle these inquiries can prepare physicians to make such decisions (Figure 1).…”