Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Learning Objectives: 1. Recognize a new format to teach end-of-life care. 2. Review the perception of learners using a serious-game framework to learn rapid discussion about goals of care.

Introduction: Emergency departments (ED) care for many patients who are chronically ill and nearing end of life. Establishing goals of care and code status in the ED is an essential skill for Emergency Medicine (EM) residents but is challenging to teach.

Educational Objectives: To develop EM residents’ ability to: 1) identify patients in need of a goals-of-care discussion; 2) interpret advance care planning documents; 3) efficiently conduct an informed code status discussion; and 4) manage the actively dying patient.

Curricular Design: High-fidelity simulation was utilized to replicate the experience of caring for a critically-ill patient in the high-stress ED environment. The scenario involved a live standardized patient with stage 4 pancreatic cancer presenting with sepsis due to pneumonia and who had the goal of comfort-focused care. The simulation utilized the Live-Die-Repeat format, which is a serious-game scheme in which learners are allowed infinite opportunities (“lives”) to progress through a single patient scenario. If learners complete the predetermined critical actions, the game is paused and there is a debriefing to reinforce knowledge and skills before resident’s progress to the next stage of the simulation. Conversely, if learners do not complete critical actions, the game is over and learners must undergo remedial debriefing before they repeat the scenario they previously failed.

Impact/Effectiveness: Eighty percent (16/20) of the residents completed a Simulation Effectiveness Tool-Modified survey and 100% strongly or somewhat agree the simulation improved their skills and confidence at the end of life including: better prepared to respond to changes in condition, more confident in assessment skills, teaching patients, reporting to the medical team, empowered to make clinical decisions, and ability to prioritize care and interventions (Figure). Comments emphasized the impact of simulation on their ability to have a goal of care discussion (Table).