Serious Illness Communication Training for Surgical Critical Care Fellows: A Pilot Implementation Study.

Objective: Effective communication about serious illness is pivotal in delivering surgical palliative care-a crucial component of comprehensive surgical critical care (SCC). However, limited educational strategies exist for fellow-level trainees, who are often directing clinical decision-making and building mutual trust with patients and families. This pilot study assess implications of a novel serious illness communication training opportunity tailored specifically for SCC fellows.
Design: Prospective implementation of a multimodal training session (1 hour-didactic lecture, 2 hours-live-action simulation), using pre- and postcourse surveys to assess self-perceived confidence.
Setting: University of Michigan in Ann Arbor, Michigan.
Participants: Eleven ACGME-accredited SCC fellows during the 2023 to 2024 academic year participated and completed all 3 survey assessments.
Results: Following the course, 6 of 7 confidence domains showed improvement, with 2 reaching statistical significance-communication skills to discuss goals of care and/or code status (3.73 vs. 4.36, p = 0.018) and end-of-life care or transition to comfort-focused care (3.36 vs. 4.18, p = 0.023) with a patient or family member. At 6-month follow up, fellows reported further increases in all queried domains, though changes were nonsignificant. Greatest absolute increases were noted in delivering serious news (4.18 vs. 4.55, p = 0.143) and expressing nonverbal empathy (4.09 vs. 4.50, p = 0.197). The majority (91%) of respondents felt more comfortable having serious illness conversations with patients and families due to their training course experience.
Conclusion: Implementation of a 3-hour training course tailored for SCC fellows significantly boosted both the immediate and long-term confidence in their serious illness communication skills and ability to manage complex care scenarios.
(Copyright © 2024 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)