M. Fiorentino1, F. Hwang1, K. Oberoi1, S. Pentakota1, A. Kunac1, S. Lamba1, A. C. Mosenthal1 1New Jersey Medical School,Surgery,Newark, NJ, USA
Introduction:
Surgical residents report lack of confidence and training in discussing goals-of-care (GOC) with patients and families, especially in emergency surgery settings. Effective July 2019 the ACGME will mandate training in GOC discussions. We evaluated the feasibility and efficacy of a simulation workshop to teach surgical residents the skills of effective communication in discussing GOC.
Methods:
Surgical residents (PGY 1 and 2) attended a two-hour simulation workshop during their weekly education time. The curriculum included: 1) an interactive didactic session on a step-by-step guide for GOC discussions, 2) small group simulation/role play sessions with 2 case scenarios with a standardized patient (SP)/family portrayed by a senior resident, and 3) debriefing and feedback by senior residents, a surgical attending board-certified in hospice and palliative medicine, and members of palliative care team. The case scenarios focused on eliciting treatment preferences from family of a patient with sepsis and a prolonged postoperative ICU stay and from a patient with a malignant bowel obstruction. A pre and post questionnaire (5-point Likert like) assessed residents’ attitudes and knowledge about GOC discussions. The responses were analyzed using a paired t-test.
Results:
20 junior surgical residents (PGY-1 and 2) participated in the workshop. Post intervention scores (“somewhat agree” or “strongly agree”) increased on knowledge (65% to 100%) and comfort in having GOC discussions (35% to 70%). Despite the increase in knowledge and comfort level, only 35% of residents felt comfortable teaching how to have GOC discussions. When comparing pre and post test workshop responses each resident, showed improvement in knowledge and comfort in discussing and teaching GOC(Table).
Conclusion:
A two-hour structured workshop increased residents’ knowledge and comfort in having GOC discussions. This session addresses a perceived gap by trainees. Case-based simulation to teach GOC discussion is feasible and effective for surgical residency programs to reproduce within budget and time constraints.
