Building the Roadmap in Critical Care Education for End-of-Life Discussions
Supporting patients and their families through the process of dying and end-of-life care is often part of critical care delivery. But how do we have conversations around death and dying? How are future physicians being taught to lead these complex discussions with patients and families? Drs. Maria Jogova, Dominique Piquette and Christie Lee, critical care physicians and faculty in the Department of Medicine, have developed a curriculum that answers these questions – a curriculum, implemented within the broader critical care learning environment, that allows physicians to build a set of integrated, holistic communications skills for conversations about end-of-life.
Exploring existing literature, the group developed a framework to help physicians structure and navigate goals of care discussions and provide patients and their substitute decision makers with emotional support. Very little literature existed that holistically covered the multiple dimensions of these conversations, including prognostication, ethico-legal considerations, and socio-cultural contexts. Further still, there was a huge gap in evaluative data on the application of these learnings in a clinical setting and the impact of educational sessions involving communication.
Conversations around end-of-life care are incredibly complex. Drs. Jogova, Piquette and Lee were seeking to develop a curriculum and framework integrating each domain of end-of-life care discussions that could be applied in the clinical learning environment and evaluated for success.
In July of 2022, the first year of this two-year curriculum was implemented over four Academic Half Day sessions. The delivery of the curriculum has been multidisciplinary, being led not only by critical care physicians, but also by psychiatrists, lawyers, ethicists and palliative care physicians. Integrating the multiple domains that apply to these complex conversations meant incorporating experts from each discipline into its delivery.
Just prior to the curriculum’s implementation, the group was a successful recipient of the Spring 2022 Strategic Medical Education Scholarship (MEdS) Grant. The grant aims to support Department of Medicine faculty in the development and evaluation of education activities, programs and products. While the curriculum had already been developed and implemented, funds from the MEdS grant will assist in a keystone portion of the project: evaluation.
The ability to formally evaluate the curriculum as an intervention in critical care education is a key differentiator from existing tools and literature in the space. Thus far, the group has been able to make educated assumptions around the success of their curriculum, but MEdS funding will provide an opportunity to qualitatively understand the impact of their sessions on the learning environment. Evaluation will inform on the sustainability and scalability of the program – understanding the skills being acquired and how they are being employed will enable refinement opportunities critical to the continued utility of the program.
While the current focus is within critical care, the ultimate goal is to deliver this curriculum to other programs. Conversations around end-of-life, while common in critical care, are not unique to the specialty. Enabling training physicians across the spectrum of medicine to learn about these conversations in a holistic way and practice them in simulated scenarios will be of benefit to physicians and their patients across the healthcare system.
