ABSTRACT #59

DIFFICULT CONVERSATIONS AND EFFECTIVE COMMUNICATION TRAINING FOR INTERNAL MEDICINE RESIDENTS: AN INNOVATIVE APPROACH THROUGH SIMULATION

Ariela Hazan, Jeeyune Bahk, Ariel Gordon, Neha Debnath, Priscilla Loanzon, James Salonia, Susannah Kurtz

PURPOSE AND GOALS: Given the lack of formal training surrounding delivering bad news and having difficult conversations, we initiated a multi-faceted simulation session to address this gap. This approach included both an introduction session and a novel simulation session, conducted in a simulation lab. The goal would be to increase resident comfort with common terms/phrases surrounding difficult conversations (such as NURSE statements and using the SPIKES framework). By using the simulation lab, we created real-life scenarios where residents may conduct these conversations in a controlled and standardized environment that maintains psychological safety, while receiving constructive feedback.

METHODS: A few days prior to the simulation session, an email with informative graphics about the SPIKES protocol and NURSE statements, as well as a video link portraying a simulated doctor-patient conversation utilizing the SPIKES protocol. Upon arrival to the SIM session, learners were asked to complete a pre-session survey and then received the SIM session introduction, including a review of the SPIKES protocol, NURSE statements and medical history of a simulated patient. Prior to entering the simulation, each learner was assigned a role within the SPIKES protocol for which they were responsible for handling during the session. They participated in a pre-interview huddle with a member of the Chaplaincy who acted as the mentor and expert. During the session, a Simulation Faculty facilitator completed an actionable items checklist. After the simulation concluded, a debrief and feedback session was held with the learners, Faculty and Chaplain. Learners were then asked to complete a post-session survey.

EVALUATION PLAN: We plan to use pre-session and post-session surveys to evaluate a change in subjective comfort and objective knowledge on the SPIKES protocol and NURSE statements. We also hope to disseminate a follow-up survey 3-6 months from initiation of this SIM lab to assess retention and retrospective applicability.

SUMMARY OF RESULTS: Simulation sessions started in January, 2023, data is still being collected. Preliminary results will be available by March 2023.

REFLECTIVE CRITIQUE: Though a simulated session is not as accurate as a real-life encounter, we hope that it will be a suitable introduction to using the SPIKES framework and a safe environment in which to practice these difficult conversations. We hope to increase comfort with and knowledge of these tools, and measure those with survey data, understanding the limitation of responses given the multiple-choice format. Limitations to our study include difficulty in standardization of sessions given varied facilitators, learner buy-in during a SIM session, ability to suspend disbelief in a simulated session, and applicability to real-life scenarios.