Simulation-Based Training to enhance Medical trainees Communication, Ethical reasoning ,and Teamwork in End-of -Life Care

  Simulation-Based Training to Enhance Medical trainees Communication, Ethical Reasoning, and Teamwork in End-of-Life Care

 I Bargaoanu1; A Fletcher1; W Lea2; M Cullen2 

York and Scarborough Teaching Hospital Foundation Trust 

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