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

Summary

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

Abstract

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’ 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 “right way.” 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.

Introduction

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 disorder^3,4,5. It is paramount for emergency medicine ....

Protocol

All methods described here were found to be exempt from review by the Indiana University Institutional Review Board.

1. Preparation

1. E-mail the GRIEV_ING pocket card (Figure 1) to all faculty one week prior to the scheduled simulation session.
2. E-mail the death notification simulation scenarios (Supplement 1), that include patient role and background history, to the standardized patients one week prior to the scheduled simulation session.
3. Pre....

Results

As noted in Ahmed et al., the study involved 22 emergency medicine residents¹². Learners’ 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 provided .......

Discussion

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 experience^13,14,15. In addition, the curriculum requires that educators provide learners with an overvie.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Chair
Facial Tissues			Standardized patients will need for simulated crying
GRIEV_ING pocket card
Stool