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Developing a Simulation Curriculum to Teach Communication in Medicine Difficult Conversations in Ped

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Abused children are more likely to have signs of injury to multiple areas of the ... Educational Objectives of Sudden Unexpected Child Death Module ... – PowerPoint PPT presentation

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Title: Developing a Simulation Curriculum to Teach Communication in Medicine Difficult Conversations in Ped


1
Developing a Simulation Curriculum to Teach
Communication in Medicine Difficult Conversations
in Pediatric Emergencies Susan Duffy, MD MPH
Attending Physician Pediatric Emergency Medicine
Hasbro Childrens Hospital, Providence, RI
Associate Professor Emergency Medicine and
Pediatrics Brown Medical School
2
The Simulation of Realistic Medical Encounters
Unique Benefits
  • Integrates training of the medical management of
    specific emergencies with relevant communications
    issues
  • Clinical skills
  • Emergency assessments and differential
    diagnoses
  • Interventions and procedural techniques
  • Acute medical management
  • Communication and interviewing skills
  • Recognition of social crises and their occult
    presentations
  • Approaching difficult conversations and
    interactions
  • Supporting families
  • Managing social emergencies

3
Medical Management issues specific to
Pediatrics Requiring unique communication skills
  • Child abuse
  • Sudden unexplained death of child
  • Child neglect
  • Parental refusal of care
  • Domestic Violence involving caretakers
  • Parental Hostility
  • Adolescent autonomy
  • Custody issues

4
Create a Pediatric Emergency Medical Simulation
Module I for Trainee Education
  • Infant with altered level of consciousness
  • Victim of child abuse
  • Shaken Baby Syndrome
  • Occult presentation
  • Parents supply no history of trauma, father is
    hostile to staff
  • Infants mother is a victim of domestic violence
  • Infant requires emergent resuscitation

5
Determine Educational Objectives and Time
Limits Before Creating Simulation Scenarios
6
Educational Objectives of Child Abuse Module
  • CLINICAL OBJECTIVES
  • 1. The recognition and acute management of an
    infant who presents with an altered level of
    consciousness
  • 2. The management of acute head injury and its
    complications in infants
  • 3. An understanding of the occult presentations
    of injury in infants

7
Educational Objectives of Child Abuse
Module Enhance Recognition that Child Abuse
  • Is not an uncommon cause of injury in children
  • Is under recognized and under reported in health
    care settings
  • Must be entertained in the evaluation of all
    injured and critically ill children
  • Screening questions should be incorporated into
    routine emergency department medical histories of
    pediatric patients

8
Educational Objectives of Child Abuse
Module Enhance Clinical Recognition of the signs
and symptoms of child abuse
  • Abusive head injury is the 1 cause of
    significant mortality and morbidity in abused
    children
  • Historical factors are key to the diagnosis
  • Abused children are more likely to have signs of
    injury to multiple areas of the body than
    children with accidental head injury
  • Child abuse and domestic violence frequently
    co-occur in families

9
Educational Objectives of Child Abuse
Module Increase Trainee Awareness
  • That they may not obtain a truthful history from
    caregivers of abused children
  • That untruthful histories may effect their
    diagnostic considerations
  • That personal biases may hinder their
    recognition of child abuse

10
Educational Objectives of Child Abuse
Module Enhance Trainee Skills
  • Asking questions about child abuse in a
    straightforward, caring and nonjudgmental manner
  • Managing hostile or potentially hostile
    interactions with families of possibly abused
    children
  • Mobilizing resources to insure the safety of
  • the patient and other family members
  • the medical staff
  • Other children in the home

11
Educational Objectives of Child Abuse Module
Trainees learn the legal responsibilities related
to
  • Reporting child abuse to state protective
    services and law enforcement.
  • The co-occurrence of child abuse and domestic
    violence.

12
Create a Pediatric Emergency Medical Simulation
II for Trainee Education
  • Sudden unexplained death of an infant
  • Infant found unresponsive at home by parents
  • EMS unsuccessfully start resuscitation
  • Infant arrives in the emergency department
    asystolic
  • Accompanied by parents

13
Educational Objectives of Sudden Unexpected Child
Death Module
  • Clinical Objectives
  • 1. Application of the ACLS Asystole Protocol
  • for infants/children
  • 2. Recognition of the reversible causes of arrest
    (4Hs and 4Ts)and
  • 3. Appropriate clinical responses and procedures
  • 4. Understanding of the outcomes of
    cardiopulmonary arrest in children

14
Educational Objectives of Sudden Unexpected Child
Death Module Enhance Trainee Understanding
  • Of the issues involved with family presence
    during pediatric resuscitation
  • Need to support families during resuscitation
  • Ask families if they want to be present
  • Always provide a specific facilitator to support
    families
  • Be prepared to communicate childs current
    condition to family and expected course with
    interventions

15
Educational Objectives of Sudden Unexpected Child
Death Module Increase Trainees Awareness
  • The needs and desires of survivors after a
    childs death
  • Empathy
  • truthfulness
  • The factors that may prevent providers from
    meeting families needs
  • Lack of understanding or education of families
    needs
  • View the death as a personal failure
  • Providers defensive reaction
  • Providers own emotional response to the death

16
Educational Objectives of Sudden Unexpected Child
Death Module Enhance Trainees Skills at
Delivering Bad News
  • Provide an appropriate environment
  • Gather support services
  • Identifying caregivers to receive information
  • Introduce self and role
  • Use the childs name
  • Speak Simply and directly

17
Educational Objectives of Sudden Unexpected Child
Death Module Enhance Trainees Skills at
Delivering Bad News
  • Express Sorrow
  • Provide information in increments
  • Provide information about resuscitation efforts
    and attempts to address pain and suffering
  • Provide opportunities for the family to express
    grief and ask questions

18
Educational Objectives of Sudden Unexpected Child
Death Module Enhance Trainees Skills at
Delivering Bad News
  • Take time…..
  • Maintain composure
  • Anticipate questions
  • Respect the familys cultural preferences
  • Ensure that the family is supported

19
Steps to creating a pediatric emergency
management/communication medical simulation module
20
Develop Standardized Parent Training
  • Role Playing
  • Recruit standardized parents who are not known to
    participants
  • Use scripted scenarios and behaviors and provide
    explanations of roles
  • Use videotaped sessions to train
  • Use the same group of standardized parent in the
    same roles for all sessions

21
Develop Standardized Parent Training
  • Have standardized parents and faculty evaluate
    trainee performance
  • Use validated checklist instruments that assess
  • Clinical assessments and intervention
  • Informational content provided to families
  • Counseling skills
  • Ask trainees to evaluate their own performance
    and experiences

22
Use Evaluation Instruments to Assess Trainees in
  • Clinical assessment and interventions
  • Informational content provided to families
  • Content Checklist
  • Counseling and communication skills
  • Gibbs Trust Scale
  • Patient Perception Questionnaire

23
Provide Feedback to Trainees
  • Standardized patients and faculty provide
    feedback during videotape review
  • Use model scenario videotapes created by
    standardized patients and faculty to demonstrate
    interview techniques and teaching points
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