Does simulation have a role in palliative medicine specialty training?

Walker, Lucy; Russon, Lynne

doi:10.1136/bmjspcare-2015-001061

Cited by 7 publications

(4 citation statements)

References 23 publications

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“…Delirium was also addressed in one study, along with pain and nausea 20. One study utilized a technologically advanced mannequin to test PC trainees in the UK on their management of massive hemorrhage, dyspnea, and opioid toxicity 21. The least commonly addressed skill included in simulation experiences was team communication, addressed in only 6% of the studies.…”

Section: Resultsmentioning

confidence: 99%

“…Furthermore, the transfer of learning and level of fidelity were not strongly correlated when a high-fidelity mannequin was compared to low-fidelity methods in teaching skills such as auscultation, cardiopulmonary resuscitation, and certain surgical techniques 46. In spite of these nuances in terminology, learners have reported that technologically advanced simulation centers contribute to the realism of the experience 21. However, learners also reported that the addition of a human SP to a robotic simulator was what made the experience “realistic, powerful and moving” 47…”

Section: Discussionmentioning

confidence: 99%

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Simulation training in palliative care: state of the art and future directions

Kozhevnikov¹,

Morrison²,

Ellman³

2018

AMEP

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BackgroundThe growing need for palliative care (PC) among patients with serious illness is outstripped by the short supply of PC specialists. This mismatch calls for competency of all health care providers in primary PC, including patient-centered communication, management of pain and other symptoms, and interprofessional teamwork. Simulation-based medical education (SBME) has emerged as a promising modality to teach key skills and close the educational gap. This paper describes the current state of SBME in training of PC skills.MethodsWe conducted a systematic review of the literature reporting on simulation experiences addressing PC skills for clinical learners in medicine and nursing. We collected data on learner characteristics, the method and content of the simulation, and outcome assessments.ResultsIn a total of 78 studies, 76% involved learners from medicine and 38% involved learners from nursing, while social work (6%) and spiritual care (3%) learners were significantly underrepresented. Only 16% of studies involved collaboration between participants at different training levels. The standardized patient encounter was the most popular simulation method, accounting for 68% of all studies. Eliciting treatment preferences (50%), delivering bad news (41%), and providing empathic communication (40%) were the most commonly addressed skills, while symptom management was only addressed in 13% of studies. The most common method of simulation evaluation was subjective participant feedback (62%). Only 4% of studies examined patient outcomes. In 22% of studies, simulation outcomes were not measured at all.DiscussionWe describe the current state of SBME in PC education, highlighting advances over recent decades and identifying gaps and opportunities for future directions. We recommend designing SBME for a broader range of learners and for interprofessional skill building. We advocate for expansion of skill content, especially symptom management education. Finally, evaluation of SBME in PC training should be more rigorous with a shift to include more patient outcomes.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Simulation training in palliative care: state of the art and future directions

Kozhevnikov¹,

Morrison²,

Ellman³

2018

AMEP

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“…Palliative medicine trainees are expected to be able to manage and prove competencies in emergencies like anaphylaxis, opioid toxicity and terminal haemorrhage 17. HFS is now used to train and assess palliative medicine trainees in these acute scenarios 18. Simulation allows trainees to refresh and demonstrate competencies for infrequent but important events and is underutilised.…”

Section: Discussionmentioning

confidence: 99%

State of the science: the doll is dead: simulation in palliative care education

Evans

Taubert

2018

BMJ Support Palliat Care

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ObjectivesBoth simulation and high-fidelity simulation involving manikins, clinical training suites, wards, computer programs and theatres have established themselves in medical undergraduate and postgraduate education. Popular among students, they have been shown to be effective learning tools. Contrasted with this is the potential risk to patients and their proxy associated with learning ‘at the bedside’, which can pose a real challenge in medical and palliative settings. The need for education and training methods that do not expose the patient to preventable communication blunders from less experienced practitioners is a priority.MethodsHere, we provide a summary review on the current literature and evidence for simulation and high-fidelity simulation in palliative and end-of-life care settings, and discuss potential uses of technologies including virtual and augmented reality in future training.ResultsThe most common form of simulation in palliative medicine is often an actor-based role-play scenario with particular emphasis on communication skills. This is expensive and time-consuming to set up. Less evidence was found on the use of high-fidelity simulation in end-of-life care teaching.ConclusionPalliative medicine has been slow to adapt to an educational method and environment that now is widely used across other areas of healthcare. There has been less emphasis on training with manikins and even less on using computer simulation and virtual reality environments to recreate challenging end-of-life care scenarios. We provide some examples of where this could benefit the curriculum.

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“…Within palliative medicine, there is emerging use of simulation, although evidence of this more frequently occurs within an adult palliative medicine setting 2–6. Within paediatric palliative medicine (PPM), use of simulation teaching appears more limited, although this has been used in the UK to upskill hospice-based staff 7.…”

Section: Introductionmentioning

confidence: 99%

Better general paediatric and neonatal palliative care skills: simulation teaching

Taylor

Nair

Grimbley

2022

BMJ Support Palliat Care

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ObjectivesTo assess the role of simulation to teach ‘palliative care’ skills to the multidisciplinary team (MDT) within general paediatric and neonatal settings.MethodsFive simulation sessions were undertaken. The themes were acute presentation of a patient with a deteriorating life-limiting condition with no advance care plan (ACP) in place and parents not wishing for escalation of treatment; putting wishes expressed in an ACP in place for a dying child; managing an expected death; putting an antenatal ACP into place at delivery; and withdrawal of life-sustaining respiratory support in an extremely preterm neonate. Simulations were attended by the MDT. Participants completed feedback rating enjoyment, organisation, quality and relevance of sessions, and likelihood of attending further paediatric palliative medicine (PPM) simulation sessions, alongside a 10-point confidence scale rating confidence in dealing with ‘palliative care’ scenarios and talking to families about death.ResultsParticipants reported they enjoyed the sessions (mean score 4.5, range 1–5) and felt they were well organised (4.7/5, range 1–5) and of high quality (4.7/5, range 1–5). They felt sessions were relevant to their training (4.6/5, range 1–5) and that they would attend further simulation training in the area of PPM (mean 4.8/5, range 1–5). Confidence in managing PPM scenarios increased by a mean of 2.3 confidence points (range −1 to 5) and confidence in talking about death increased by a mean of 1.7 confidence points (range 0–5).ConclusionsPPM simulation training was acceptable to participants and effective in increasing confidence with PPM skills. Training in PPM simulation should be a routine part of paediatric and neonatal training across the MDT.

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Does simulation have a role in palliative medicine specialty training?

Cited by 7 publications

References 23 publications

Simulation training in palliative care: state of the art and future directions

Simulation training in palliative care: state of the art and future directions

State of the science: the doll is dead: simulation in palliative care education

Better general paediatric and neonatal palliative care skills: simulation teaching

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