Simulation-Based Training to enhance Medical trainees Communication, Ethical reasoning ,and Teamwork in End-of -Life Care
Abstract
Introduction: Delivering compassionate, patient-centred care at the end of life requires internal medicine trainees to demonstrate effective communication, ethical decision-making, and multidisciplinary teamwork.
Simulation-based education offers a safe, structured environment to practise these skills and reflect on their ethical dimensions.
Method : A survey was conducted before and after the simulation session.
This survey evaluated the impact of simulation-based training on internal medicine trainees interpersonal, ethical, and collaborative competencies in end-of-life (EOL) care for older adults, with a particular focus on respect and dignity.
Participants undertook four high-fidelity simulation scenarios: an EOL discussion with an elderly patient with cognitive impairment and family conflict, an acute deterioration requiring multidisciplinary coordination and escalation decisions, patient with Parkinson’s disease and frailty developing significant swallowing issues which required decision making around nutrition and elderly patient with fall and head injury and complex decision making/capacity assessment/needing neurosurgical intervention. Performance was assessed using OSCE-style checklists, global ratings for communication and teamwork, and filling in Respect form.
Four candidates participated actively in the scenarios the rest contributed to the debrief by giving feedback turning it into a very interactive session. The debrief was delivered by the tutors in a structured way as per the DIAMOND method.
Pre- and post-training surveys measured communication efficiency.
Results : Post-training results demonstrated significant improvements in communication confidence, ethical reasoning, MDT collaboration, and observed respectful behaviours. Participants reported enhanced confidence in managing ethically complex EOL discussions and greater appreciation of team roles and shared decision-making
Comments
Important topic
Very important topic
It would be interesting to see whether this improvement continued in the long term. Would you repeat this after a period of time e.g. six months?
Fantastic!
Conversations regarding end of life care can be daunting! It’s great to see medical trainees being able to practice having these difficult discussions in a simulated environment!
Answer
Thank you for your comments. We been doing this sessions 2 monthly and we are planning to continue. It has proven improvement in the resident doctor's communication skill, Since we lost the fundings for the Compass course we been trying to replace with something.End of life decision making and communication around it is a big challenge for the trainees.
Debriefing
Really interesting to see simulation being used around EOL discussions. Can you give more details about the diamond method of debriefing?
Answer- Debriefing
Thank you for the question.
The Diamond method is based on the technique of description, analysis and application., an advocacy/ inquiry approach.
We found it beneficial equally for juniors and the faculty as well.
The juniors conduct the description phase , the faculty leads the more challenging phases.
Essentially is a series of structural questions in a safe , non judgemental manner.First questions are addressed to the non participating ( in the scenario)members of the audience .Questions like How did you feel ?allows to concentrate on non technical skills.
And finally the participants reflect on how they could apply this knowledge in their clinical practice.