HowToTeachTheMgntCommSimulation-overly

Developing a Simulation Curriculum to Teach Communication in MedicineDifficult Conversations in Pediatric EmergenciesSusan Duffy, MD MPH Attending Physician Pediatric Emergency Medicine Hasbro Children’s Hospital, Providence, RI Associate Professor Emergency Medicine and Pediatrics Brown Medical School : 

Developing a Simulation Curriculum to Teach Communication in MedicineDifficult Conversations in Pediatric EmergenciesSusan Duffy, MD MPH Attending Physician Pediatric Emergency Medicine Hasbro Children’s Hospital, Providence, RI Associate Professor Emergency Medicine and Pediatrics Brown Medical School

The Simulation of Realistic Medical Encounters : 

The Simulation of Realistic Medical Encounters Integrates training of the medical management of specific emergencies with relevant communications issues Clinical skills Emergency assessments and differential diagnoses Interventions and procedural techniques Acute medical management Communication and interviewing skills Recognition of social crises and their occult presentations Approaching difficult conversations and interactions Supporting families Managing social emergencies Unique Benefits

Medical Management issues specific to PediatricsRequiring unique communication skills : 

Medical Management issues specific to PediatricsRequiring unique communication skills Child abuse Sudden unexplained death of child Child neglect Parental refusal of care Domestic Violence involving caretakers Parental Hostility Adolescent autonomy Custody issues

Create a Pediatric Emergency Medical Simulation Module I for Trainee Education : 

Create a Pediatric Emergency Medical Simulation Module I for Trainee Education Infant with altered level of consciousness Victim of child abuse Shaken Baby Syndrome Occult presentation Parents supply no history of trauma, father is hostile to staff Infant’s mother is a victim of domestic violence Infant requires emergent resuscitation

Determine Educational Objectives and Time LimitsBefore Creating Simulation Scenarios : 

Determine Educational Objectives and Time LimitsBefore Creating Simulation Scenarios

Educational Objectives of Child Abuse Module : 

Educational Objectives of Child Abuse Module CLINICAL OBJECTIVES 1. The recognition and acute management of an infant who presents with an altered level of consciousness 2. The management of acute head injury and its complications in infants 3. An understanding of the occult presentations of injury in infants

Educational Objectives of Child Abuse ModuleEnhance Recognition that Child Abuse : 

Educational Objectives of Child Abuse ModuleEnhance Recognition that Child Abuse Is not an uncommon cause of injury in children Is under recognized and under reported in health care settings Must be entertained in the evaluation of all injured and critically ill children Screening questions should be incorporated into routine emergency department medical histories of pediatric patients

Educational Objectives of Child Abuse ModuleEnhance Clinical Recognition of the signs and symptoms of child abuse : 

Educational Objectives of Child Abuse ModuleEnhance Clinical Recognition of the signs and symptoms of child abuse Abusive head injury is the # 1 cause of significant mortality and morbidity in abused children Historical factors are key to the diagnosis Abused children are more likely to have signs of injury to multiple areas of the body than children with accidental head injury Child abuse and domestic violence frequently co-occur in families

Educational Objectives of Child Abuse ModuleIncrease Trainee Awareness : 

Educational Objectives of Child Abuse ModuleIncrease Trainee Awareness That they may not obtain a truthful history from caregivers of abused children That untruthful histories may effect their diagnostic considerations That personal biases may hinder their recognition of child abuse

Educational Objectives of Child Abuse ModuleEnhance Trainee Skills : 

Educational Objectives of Child Abuse ModuleEnhance Trainee Skills Asking questions about child abuse in a straightforward, caring and nonjudgmental manner Managing hostile or potentially hostile interactions with families of possibly abused children Mobilizing resources to insure the safety of: the patient and other family members the medical staff Other children in the home

Educational Objectives of Child Abuse Module Trainees learn the legal responsibilities related to: : 

Educational Objectives of Child Abuse Module Trainees learn the legal responsibilities related to: Reporting child abuse to state protective services and law enforcement. The co-occurrence of child abuse and domestic violence.

Create a Pediatric Emergency Medical Simulation II for Trainee Education : 

Create a Pediatric Emergency Medical Simulation II for Trainee Education Sudden unexplained death of an infant Infant found unresponsive at home by parents EMS unsuccessfully start resuscitation Infant arrives in the emergency department asystolic Accompanied by parents

Educational Objectives of Sudden Unexpected Child Death Module : 

Educational Objectives of Sudden Unexpected Child Death Module Clinical Objectives 1. Application of the ACLS Asystole Protocol for infants/children 2. Recognition of the reversible causes of arrest (4H’s and 4T’s)and 3. Appropriate clinical responses and procedures 4. Understanding of the outcomes of cardiopulmonary arrest in children

Educational Objectives of Sudden Unexpected Child Death ModuleEnhance Trainee Understanding : 

Educational Objectives of Sudden Unexpected Child Death ModuleEnhance Trainee Understanding Of the issues involved with family presence during pediatric resuscitation Need to support families during resuscitation Ask families if they want to be present Always provide a specific facilitator to support families Be prepared to communicate child’s current condition to family and expected course with interventions

Educational Objectives of Sudden Unexpected Child Death ModuleIncrease Trainees Awareness : 

Educational Objectives of Sudden Unexpected Child Death ModuleIncrease Trainees Awareness The needs and desires of survivors after a child’s death Empathy truthfulness The factors that may prevent providers from meeting families’ needs Lack of understanding or education of families needs View the death as a personal failure Provider’s defensive reaction Provider’s own emotional response to the death

Educational Objectives of Sudden Unexpected Child Death ModuleEnhance Trainees Skills at Delivering Bad News : 

Educational Objectives of Sudden Unexpected Child Death ModuleEnhance Trainees Skills at Delivering Bad News Provide an appropriate environment Gather support services Identifying caregivers to receive information Introduce self and role Use the child’s name Speak Simply and directly

Educational Objectives of Sudden Unexpected Child Death ModuleEnhance Trainees Skills at Delivering Bad News : 

Educational Objectives of Sudden Unexpected Child Death ModuleEnhance Trainees Skills at Delivering Bad News Express Sorrow Provide information in increments Provide information about resuscitation efforts and attempts to address pain and suffering Provide opportunities for the family to express grief and ask questions

Educational Objectives of Sudden Unexpected Child Death ModuleEnhance Trainees Skills at Delivering Bad News : 

Educational Objectives of Sudden Unexpected Child Death ModuleEnhance Trainees Skills at Delivering Bad News Take time….. Maintain composure Anticipate questions Respect the family’s cultural preferences Ensure that the family is supported

Steps to creating a pediatric emergency management/communication medical simulation module : 

Steps to creating a pediatric emergency management/communication medical simulation module

Develop Standardized ParentTraining : 

Develop Standardized ParentTraining Role Playing Recruit standardized parents who are not known to participants Use scripted scenarios and behaviors and provide explanations of roles Use videotaped sessions to train Use the same group of standardized parent in the same roles for all sessions

Develop Standardized ParentTraining : 

Develop Standardized ParentTraining Have standardized parents and faculty evaluate trainee performance Use validated checklist instruments that assess Clinical assessments and intervention Informational content provided to families Counseling skills Ask trainees to evaluate their own performance and experiences

Use Evaluation Instrumentsto Assess Trainees in: : 

Use Evaluation Instrumentsto Assess Trainees in: Clinical assessment and interventions Informational content provided to families Content Checklist Counseling and communication skills Gibbs Trust Scale Patient Perception Questionnaire

Provide Feedback to Trainees : 

Provide Feedback to Trainees Standardized patients and faculty provide feedback during videotape review Use “model scenario” videotapes created by standardized patients and faculty to demonstrate interview techniques and teaching points