The authors have no acknowledgements.

All methods described here were found to be exempt from review by the Indiana University Institutional Review Board.
1. Preparation
<ol>
	<li>E-mail the GRIEV_ING pocket card (Figure 1) to all faculty one week prior to the scheduled simulation session.</li>
	<li>E-mail the death notification simulation scenarios (<a href="https://www.jove.com/files/ftp_upload/61646/JoVE RCDP Standardized Patient Case Materials.docx" target="_blank">Supplement 1</a></stro...

<ol>
	<li>National Hospital Ambulatory Medical Care Survey: 2016 Emergency Department Summary Tables. Centers for Disease Control and Prevention Available from: <a target="_blank" href="https://www.cdc.gov/nchs/data/nhamcs/web_tables/2016_ed_web_tables.pdf">https://www.cdc.gov/nchs/data/nhamcs/web_tables/2016_ed_web_tables.pdf</a> (2016)</li><li>Waiters, D. T., Tupin, J. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Family+grief+in+the+emergency+department.">Family grief in the emergency department.</a> Emergency Medicine Clinics of North America. 9 (1), 189-206 (1991).</li><li>Breslau, N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Trauma+and+posttraumatic+stress+disorder+in+the+community:+the+1996+Detroit+area+survey+of+trauma.">Trauma and posttraumatic stress disorder in the community: the 1996 Detroit area survey of trauma.</a> Archives of General Psychiatry. 55 (7), 626-632 (1998).</li><li>Stewart, A. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Complicated+bereavement+and+posttraumatic+stress+disorder+following+fatal+car+crashes:+recommendations+for+death+notification+practice.">Complicated bereavement and posttraumatic stress disorder following fatal car crashes: recommendations for death notification practice.</a> Death Studies. 23 (4), 289-321 (1999).</li><li>Shoenberger, J. M., Yeghiazarian, S., Rios, C., Henderson, S. O. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Death+Notification+in+the+Emergency+Department:+survivors+and+physicians.">Death Notification in the Emergency Department: survivors and physicians.</a> Western Journal of Emergency Medicine. 14 (2), 181-185 (2013).</li><li>Park, I., Gupta, A., Mandani, K., Haubner, L., Peckler, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Breaking+bad+news+education+for+emergency+medicine+residents:+A+novel+training+module+using+simulation+with+the+SPIKES+protocol.">Breaking bad news education for emergency medicine residents: A novel training module using simulation with the SPIKES protocol.</a> Journal of Emergencies, Trauma, and Shock. 3 (4), 385-388 (2010).</li><li>Hobgood, C., Harward, D., Newton, K., Davis, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+educational+intervention+"GRIEV_ING"+improves+the+death+notification+skills+of+residents.">The educational intervention "GRIEV_ING" improves the death notification skills of residents.</a> Academic Emergency Medicine. 12 (4), 296-301 (2005).</li><li>Chancey, R. J., Sampayo, E. M., Lemke, D. S., Doughty, C. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Learners'+Experience+During+Rapid+Cycle+Deliberate+Practice+Simulations:+A+Qualitative+Analysis.">Learners' Experience During Rapid Cycle Deliberate Practice Simulations: A Qualitative Analysis.</a> Simulation in Healthcare. 14 (1), 18-28 (2019).</li><li>Hunt, E. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pediatric+resident+resuscitation+skills+improve+after+"rapid+cycle+deliberate+practice"+training.">Pediatric resident resuscitation skills improve after "rapid cycle deliberate practice" training.</a> Resuscitation. 85 (7), 945-951 (2014).</li><li>Taras, J., Everett, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Rapid+Cycle+Deliberate+Practice+in+Medical+Education-+a+Systematic+Review.">Rapid Cycle Deliberate Practice in Medical Education- a Systematic Review.</a> Cureus. 9 (4), 1180 (2017).</li><li>Ahmed, R. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Rapid+Cycle+Deliberate+Practice:+Death+Notification.">Rapid Cycle Deliberate Practice: Death Notification.</a> The Clinical Teacher. , (2020).</li><li>Stephenson, E., Poore, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Tips+for+Conducting+the+Pre-Brief+for+a+Simulation.">Tips for Conducting the Pre-Brief for a Simulation.</a> The Journal of Continuing Education in Nursing. 47 (8), 353-355 (2016).</li><li>Rudolph, J. W., Raemer, D. B., Simon, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Establishing+a+safe+container+for+learning+in+simulation:+the+role+of+the+presimulation+briefing.">Establishing a safe container for learning in simulation: the role of the presimulation briefing.</a> Simulation in Healthcare. 9 (6), 339-349 (2014).</li><li>Hughes, P. G., Hughes, K. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Briefing+Prior+to+Simulation+Activity.">Briefing Prior to Simulation Activity.</a> StatPearls. , (2020).</li></ol>

The RCDP death notification curriculum consists of several critical steps. First, the prebrief is critical to introduce the concept of RCDP and create psychological safety for learners. Learners who feel psychologically safe have less anxiety and feel more comfortable making mistakes, allowing for optimization of the learning experience13,14,15. In addition, the curriculum requires that educators provide learners with an overvie...

Death notification is an important and challenging aspect of Emergency Medicine. An emergency medicine physician must deliver bad news, often sudden and unexpected, to patients and family members without any previous relationship. On average 270,000 patients die in United States emergency departments each year1. This number is anticipated to increase as the population ages2. Unskilled death notification can lead to the development of pathologic grief and posttraumatic stress disorder3,4,5. It is paramount for emergency medicine physicians to be trained in and practice death notification.
Graduate and undergraduate medical educators employ a variety of death notification techniques when teaching residents and medical students to deliver bad news6,7,8. One example is the GRIEV_ING curriculum. It provides medical personnel a conceptual framework for death notification. The curriculum has demonstrated improvement in learners&#8217; confidence and competence when delivering bad news8.
Rapid Cycle Deliberate Practice (RCDP) is a simulation-based medical education technique that uses within-scenario debriefing9. This technique is based on the concepts of mastery learning and deliberate practice9,10,11. It allows educators to pause a scenario, provide directed feedback, and then let learners rewind and continue the simulation scenario the &#8220;right way.&#8221; The purpose of this scholarly work is to describe how to apply the Rapid Cycle Deliberate Practice debriefing technique to the GRIEV_ING death notification curriculum to more effectively train learners in the delivery of bad news12.
In preparation for this curriculum, learners are given a 45-minute lecture on the principles of death notification and the GRIEV_ING conceptual framework. Prior to starting the simulation session, faculty perform a prebrief of the objectives, RCDP and simulation environment logistic details, establish a fiction contract with the learners and pledge to respect the learners13,14,15. The learners are split into groups of 4-5 and assigned an examination room with a faculty member and standardized patient. Each learner is given a GRIEV_ING pocket card to reference during the simulation. To start, one learner is selected from each group to perform the first death notification scenario. This first death notification serves as a needs assessment for the faculty. It is allowed to run from start to finish without interruption. Next, the same learner performs a new death notification simulation using the same scenario, this time RCDP is used by the faculty to provide feedback throughout the death notification scenario. Faculty pause the scenario, provide directed feedback and then rewind the scenario 30-60 seconds. The scenario is then restarted by the standardized patient.

<table>
	<tbody>
		<tr>
			<td>Chair</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Facial Tissues</td>
			<td></td>
			<td></td>
			<td>Standardized patients will need for simulated crying</td>
		</tr>
		<tr>
			<td>GRIEV_ING pocket card</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Stool</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
	</tbody>
</table>

setup and execution of the rapid cycle deliberate practice death notification curriculum

Death notification is an important and challenging aspect of Emergency Medicine. An Emergency Medicine physician must deliver bad news, often sudden and unexpected, to patients and family members without any previous relationship. Unskilled death notification after unexpected events can lead to the development of pathologic grief and posttraumatic stress disorder. It is paramount for Emergency Medicine physicians to be trained in and practice death notification techniques. The GRIEV_ING curriculum provides a conceptual framework for death notification. The curriculum has demonstrated improvement in learners&#8217; confidence and competence when delivering bad news. Rapid Cycle Deliberate Practice is a simulation-based medical education technique that uses within the scenario debriefing. This technique uses the concepts of mastery learning and deliberate practice. It allows educators to pause a scenario, provide directed feedback, and then let learners continue the simulation scenario the &#8220;right way.&#8221; The purpose of this scholarly work is to describe how to apply the Rapid Cycle Deliberate Practice debriefing technique to the GRIEV_ING death notification curriculum to more effectively train learners in the delivery of bad news.

As noted in Ahmed et al., the study involved 22 emergency medicine residents12. Learners&#8217; median self-efficacy and knowledge scores increased from 3 to 4 and 65 to 90, respectively, when comparing pre- and post-simulation results. In addition, pre- and post-intervention death notification performance scores improved (Table 1).
Qualitative themes from the post-curriculum surveys by Ahmed et al. were that this exercise was a great experience and pro...

Watch this Scientific Journal Video about Setup and Execution of the Rapid Cycle Deliberate Practice Death Notification Curriculum at JoVE.com

Setup and Execution of the Rapid Cycle Deliberate Practice Death Notification Curriculum

The goal is to demonstrate how to apply the rapid cycle deliberate practice debriefing technique to the GRIEV_ING death notification curriculum.

Death notification is an important and challenging aspect of Emergency Medicine. An Emergency Medicine physician must deliver bad news, often sudden and ...

Our protocol describes how to apply the rapid cycle deliberate practice debriefing technique to the grieving death notification curriculum to more effectively train learners in the delivery of bad news. This method allows educators to pause a scenario, provide directed feedback, and then lets learners repeat the simulation scenario the right way. Unskilled death notification can lead to the development of pathologic grief and post-traumatic stress disorder.This method can be applied to train any healthcare provider in the delivery of bad news. One week prior to the scheduled simulation session, email the grieving pocket card to all faculty. Also email the death notification simulation scenarios, including patient role and background history, to the standardized patients.Before beginning the death notification simulation exercise, prepare the examination rooms by placing a chair for the standardized patient, and a stool for the learner in each room. Print patient scenario information, which includes name, age, gender, background, condition, and survivor present. Then post it outside each exam room for learners.Have faculty read the death notification scenarios prior to the start of the session. Gather all faculty and learners in one room and review the simulation session goals and objectives. Form a fiction contract with the learners and pledge to respect them.Divide the learners into groups of no more than four to five and give each learner a grieving pocket card to reference during the simulation. Select one learner from each group to perform the initial death notification scenario. Position the standardized patient in the exam room and have the learners review the simulation scenario case details posted outside the exam room.Start the initial death notification scenario and run it from start to finish without interruption. Identify specific areas that necessitate feedback, then perform a micro-debriefing at the conclusion of the first scenario. Give succinct feedback to learners on initial performance in less than five minutes.Reset the scenario and place the learners outside the room. Perform the same simulation scenario from the beginning, starting with the same learner as the leader for the second round of the scenario. Apply the RCDP technique during the scenario.Pause the scenario, provide directed feedback, and then rewind the scenario 30 to 60 seconds. Have the standardized patient restart the scenario. Perform a micro-debriefing at the conclusion of the scenario training period, providing constructive feedback the learners.Repeat the scenario again from the start and continue with the RCDP approach. When finished, gather all faculty and learners in one room for a 15 minute group wrap-up. Focus on key take home points from the training and allow for learner feedback.This protocol was implemented on 22 emergency medicine residents. Learners'median self-efficacy and knowledge scores increased from three to four and 65 to 90, respectively, when comparing pre-and post-simulation results. In addition, pre-and post-intervention death notification performance scores improved.Post-curriculum surveys indicated that this exercise was a great experience and provided instant feedback. Residents felt the RCDP death notification curriculum solidified their death notification skills and allowed them the opportunity to refine their technique. Only one resident preferred the traditional simulation method with no interruptions.When performing this protocol, remember to wait until the second round of the scenario before applying the rapid cycle deliberate practice technique. Future directions for this study include investigating how this curriculum translates to the clinical environment.

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4.1K vistas.  Florida Atlantic University Schmidt College of Medicine. Nuestro protocolo describe cómo aplicar la técnica de debriefing de práctica deliberada de ciclo rápido al currículo de notificación de muerte afligida para capacitar más eficazmente a los estudiantes en la entrega de malas noticias. Este método permite a los educadores pausar un escenario, proporcionar comentarios dirigidos y, a continuación, permite a los alumnos repetir el escenario de simulación de la manera correcta. La notificación de muerte no calificada puede conducir al de...