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.
