An Intensive, Simulation-Based Communication Course for Pediatric Critical Care Medicine Fellows

Abstract

Objective Effective communication among providers, families, and patients is essential in critical care, but is often inadequate in the pediatric ICU. To address the lack of communication education PCCM fellows receive, the Children’s Hospital of Pittsburgh PICU developed a simulation-based communication course, Pediatric Critical Care Communication Course (PC3). PCCM trainees have limited prior training in communication and will have increased confidence in their communication skills after participating in the PC3 course. Design PC3 is a 3-day course taken once during fellowship featuring simulation with actors portraying family members. Prior to and after the course, fellows complete an anonymous survey asking about 1) prior instruction in communication 2) preparedness for difficult conversations, 3) attitudes about end-of-life care, and 4) course satisfaction. We compared pre- and post-course surveys using paired student’s t-test. Main Results Most of the 38 fellows who participated over 4 years had no prior communication training in conducting a care conference (70%), providing bad news (57%), or discussing end of life options (75%). Across all four iterations of the course, fellows after the course reported increased confidence across many topics of communication, including giving bad news, conducting a family conference, eliciting both a family’s emotional reaction to their child’s illness and their concerns at the end of a child’s life, discussing a child’s code status, and discussing religious issues. Specifically, fellows in 2014 reported significant increases in self-perceived preparedness to provide empathic communication to families regarding many aspects of discussing critical care, end of life care and religious issues with patients’ families (p<0.05). The majority (90%) of fellows recommended that the course be required in PCCM fellowship. Conclusions The PC3 course increased fellow confidence in having difficult discussions common in the PICU. Fellows highly recommend it as part of PICU education. Further work should focus on the course’s impact on family satisfaction with fellow communication.

Simulation-based education to promote confidence in managing clinical aggression at a paediatric hospital

“…This study confirmed that staff self-reported confidence levels in managing clinical aggression can be increased through completion of a 2-h simulation training programme and adds to the body of literature that simulation training programmes can improve non-technical skills in health care staff: staff confidence [64], communication skills [33,65], leadership skills [66][67][68], team skills [28,69,70], knowledge acquisition and retention [71] and skills in aggression management [37,38,61,72]. The use of a simulated patient exercise to practice de-escalation techniques has been described in some acute care hospitals [12,18,20,21,61] and for undergraduate nursing students [37,38]; however, widespread use of simulation courses for managing aggression in children and young people in acute health care, and in particular paediatric settings, has not been reported until this study.…”

“…Simulation training to teach and practice resuscitation and other technical skills is well described in the paediatric acute care literature [28][29][30]. Similarly, the practice of non-technical skills such as communication techniques is also described in the simulation literature [31][32][33]. Simulation-based education may be an effective format to practice de-escalation skills for aggressive behaviour [34][35][36][37][38].…”

Techniques to Communicate Better With Parents During End-of-Life Scenarios in Neonatology

“…6,7 Simulation-based medical education has helped clinicians improve their communication skills, 8 often incorporating standardized actors in medical curricula. 9 Realism is an important concept in simulation; the use of high-fidelity simulators results in improved cognitive performance in pediatric providers. 10 On the other hand, other aspects of realism have been neglected.…”

Communication training for inter‐specialty clinicians

“…We developed a 2‐day communication skills training workshop for paediatric clinicians, faculty members and nurse‐practitioners (NPs) based on a critical care communication (C3) course . Our modifications were targeted towards tailoring the experience to paediatric clinicians and addressing some perceived educational barriers.…”

“…We developed a 2 day communication skills training workshop for paediatric clini cians, faculty members and nursepractitioners (NPs) based on a critical care communication (C3) course. 6,7 Our modifications were targeted towards tailoring the experience to paediatric clinicians and addressing some perceived educational barriers. The purposes of this paper are to describe an ICU focused commu nication skills workshop to teach physicians and NPs the core communication skills needed to co lead family centred confer ences, and to assess its feasibil ity and self assessed impact.…”