Oral Themed Presentation
Context: : Paediatric and neonatal death is infrequent, but devastating. There are >900 deaths per year in infants alone in Australia (1). Both expected and unexpected death can have profound impacts on family as well as staff. Facilitating skill development for effective communication with the family in these difficult situations is essential. Previous research demonstrates that paediatric doctors feel ill equipped to communicate with families in these situations (2-5). Simulation has long been studied as a safe environment in which to experiment with and improve skills, while providing adequate briefing, support and debriefing (6-8, 9,10)
Description: : The pilot program assessed was a novel integration of ALOBA- based (11) communication skills training relating to values-based goals of care (using Thinking Ahead Framework, attached), followed by resuscitation scenarios informed by the completed goals of care forms. This formed part of a broader implementation of the Thinking Ahead Policy produced by SaferVic informing the new Barwon Health Framework and Guide. Participants in the pilot program were consultant paediatricians working at University Hospital Geelong, a regional paediatric centre with a special care nursery and four paediatric ICU beds. The program is currently being adapted and run in other areas of Australia.
Observation/Evaluation: : Clinicians who taking part in the initial Paed SimComm program were invited to complete a quality assurance survey immediately after the program, as well as a second survey six months later (data currently being collected), reflecting on translation from the program into clinical practice. Ethics approval was obtained from Barwon Health: BH 17/198
Discussion: : A total of 7 consultant paediatricians took part in both the communication and simulated resuscitation sessions. Consultant experience ranged from 1-5 years (33.3%) through to more than 15 years (22.2%). The majority of the paediatricians had minimal experience in either having advanced care discussions or providing palliative care at the end of a child’s life, with 66.7% having had ≤3 encounters. Goals of Care forms were infrequently documented for children with life-limiting illnesses at medical emergency calls or code blue calls, and all felt that this was suboptimal.
Prior to this program, 88.9% of the paediatricians had not previously used the ‘Thinking Ahead’ framework. By the end of the program, 100% of the participants felt comfortable using the framework and that it was useful for advanced care planning. The majority (77.8%) had some previous experience in communication skills training, but the bulk of this was in medical school. 85.7% of the cohort found it easy to integrate the ‘Thinking Ahead’ framework into the resuscitation scenario with 72% reporting it enhanced their learning. The outcome for both scenarios was death; 100% of the clinicians felt comfortable with this outcome. 71.4% of the paediatricians felt that this simulation program was ‘quite’ helpful in preparing them for future clinical situations involving death in paediatrics. All of the paediatricians felt it was advantageous to do the simulation with their colleagues.
Combining communication training and simulated resuscitation in the one program was acceptable and effective at a consultant level. The program was effective at teaching communication skills that enhanced the consultants' skills in the simulated scenarios. Furthermore, skills learned have the potential to translate into changes in clinical practice.