Mock No Code: A Simulation Curriculum for Responding to Patients With Varying Goals of Care.

CONTEXT: Identifying the limits of medical interventions to sustain life, navigating advance care plans (ACP), and managing symptoms at end-of-life are critically important skills to pediatric residents who care for children with serious illnesses in high-acuity clinical settings. However, pediatric residents report inadequate training in primary palliative care skills. Simulation-based Mock Code training is an education modality used to practice high-stakes skills in a controlled environment. Leveraging the structure of Mock Code simulations, our team generated a novel Mock No Code curriculum to build primary palliative care skills.

OBJECTIVES: To increase pediatric resident comfort and confidence in navigating resuscitation and communication when a child with a life-limiting illness and an ACP experiences acute clinical decompensation.

METHODS: This cohort study compared pediatric residents at a single institution, exposed and not exposed to the Mock No Code curriculum between April 2019 and September 2022. Residents were surveyed with Likert-style questions on comfort and/or confidence with various aspects of care in patients with limitations on life-prolonging interventions.

RESULTS: Surveys were administered over a three-year period with 151 responses: 105 residents were exposed to the curriculum, and 46 residents were not. Exposure to the Mock No Code curriculum was associated with higher levels of comfort and confidence in interpreting and following an ACP during a code event.

CONCLUSION: The Mock No Code curriculum is effective in increasing comfort and confidence among pediatric residents in caring for patients with limitations in life-prolonging interventions and can better prepare residents for acute clinical encounters with varying goals of care.