Resident perceptions of a novel virtual serious illness communication skills curriculum incorporating medical management: qualitative analysis of participant group interviews.

BACKGROUND: Emergency medicine (EM) and internal medicine (IM) physicians care for patients in settings where prompt recognition of and effective communication about acute decompensation and the potential for imminent death is crucial to providing goal-concordant care. Competence in these tasks requires dedicated training and facilitated practice in serious illness communication (SIC). Existing simulation-based SIC curricula typically utilize cases in which the diagnosis and prognosis are already established in a medically stable patient, representing a missed opportunity for learners. To fill this gap, the authors aimed to explore IM and EM resident perceptions of a novel, entirely virtual SIC curriculum, Managing Acute Decompensation in Life-limiting Illness (MADLI), that required participants to assess and manage a clinically decompensating seriously ill patient while simultaneously incorporating newly learned SIC skills.

METHODS: Sixteen participants were recruited from the EM and IM residency programs at a large, tertiary, academic medical center. Using a "flipped classroom" approach, residents asynchronously viewed a 20-minute didactic video introducing evidence-based communication frameworks. In small peer groups led by a trained faculty facilitator, they then participated in a 60-minute simulated clinical encounter involving an acutely decompensating patient and their surrogate decision maker, played by an SIC-trained actor. Lastly, residents participated in a 30- to 60-minute semi-structured group interview. Qualitative thematic analysis was performed to identify overarching themes that resulted from the interview data.

RESULTS: Qualitative analysis of group interview transcripts yielded 3 major themes that reflect the trainee experience with the MADLI curriculum: (I) simulation unmasked moral challenges; (II) simulation facilitated safe practice and identification of knowledge gaps for SIC skills; and (III) task switching and case realism were virtual SIC curricular elements that promoted learner engagement and effective learning. Additionally, integrating medical management and SIC tasks was perceived as novel, challenging, and realistic. Residents who completed the MADLI curriculum viewed it as an effective modality to teach SIC.

CONCLUSIONS: Simulation-based curricula for EM and IM residents that combine medical management, prognostication, and complex SIC into a single virtual, simulated patient encounter can address critical gaps in resident education related to the management of seriously ill patients at high risk of imminent death. Incorporating a trained actor and task-switching enhanced realism and learner engagement, highlighting the value of this model as a feasible approach to advancing IM and EM resident SIC skills.