1. Using Simulated Encounters with Standardized Patients to Teach and Evaluate Difficult Discussions Rebecca Stetzer, MD Kathleen M Young, PhD, MPH Albany Medical College Family Medicine Residency Program Albany, NY

2. Disclosures Unfortunately, none.

3. Objectives Work with a simulation center to develop curriculum for teaching facilitation of difficult discussions. Use standardized measurement to assess resident experiences and skills related to facilitating difficult discussions. Plan a difficult discussions curriculum relevant to family physicians.

4. Simulation Center Patient Safety and Clinical Competency Center –(PSCCC; Albany Medical College) Standardized patients (SPs) Simulated Exam rooms –Video and audio feed with recording capabilities –Computers for SP feedback Observation rooms with multiple monitors

5. PSCCC at AMC Direct observation into simulation environment Observation room for live audio/video feed

6. Curriculum Components “Classroom Case” –One-hour –Didactic on discussing code status –Difficult discussion demo with palliative care physician and SP Sim Center “Workshop” –2 ½ hours –Difficult discussion didactic (based on SPIKES 1,2,3 ) –Resident practice with two SP cases –Debriefing session

7. Brief Project Proposals Objectives: –Develop techniques for delivering bad news and discussing treatment options –Practice skills –Increase comfort Case descriptions –Elderly patient admitted to hospital with pneumonia –New pancreatic cancer diagnosis with poor prognosis (plus spouse) –End stage COPD with new MI/CHF

8. Brief Project Proposals Logistics: –Staff/Faculty –Equipment –Space (Conference, exam, observation rooms) Assessment: –Resident self-evaluation (pre- and post-) –SP –Faculty observation –Debriefing

9. Measures Resident self-evaluation (Orgel et al., 2010 4 ) SP feedback –Checklist –Comments Faculty evaluation –Milestones checklist –Comments Debriefing –Discussion –Comments @ end of self-evaluation

10. Process Faculty Benefits –Opportunity for direct observation –Guidance for clinical teaching strategies –Milestones data Resident Benefits –Safe space to practice skills (for residents and patients) –Opportunity for feedback and discussion

11. Lessons Learned Alterations to measurement –Evaluate skills before and after education session –More feedback on resident perceptions of activities –Add faculty measure Improving resident feedback process Decreasing “down time” –Add resident-led didactics on disease presentations?

12. Future Developments Other conversations relevant to family medicine –Geriatric –Adolescent –Maternity/child 3 year curriculum – Rotate topics

13. Questions? References 1.Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP. SPIKES—A six- step protocol for delivering bad news: application to the patient with cancer. Oncologist. 2000;5(4):302-311. 2.“Serious Illness Conversation Guide.” Draft R3.0 07/30/12. Accessed at Practical Aspects of Palliative Care, Harvard Medical School, October 2013 3.Weissman DE, Quill TE, Arnold RM. The Family Meeting: End of Life Goal Setting and Future Planning. Fast Facts and Concepts. February 2010; 227. Available at http://www.eperc.mcw.edu/EPERC/FastFactsIndex/ff_227.htm. 4.Orgel, Etan, Robert McCarter and Shana Jacobs. A Failing Medical Educational Model: A Self-Assessment by Physicians at All Levels of Training of Ability and Comfort to Deliver Bad News. J Pall Med 2010;13(6) 677-683.

14. Please evaluate this session at: stfm.org/sessionevaluation