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December 2022; 1 (2) Research ArticleOpen Access

Curriculum Innovations: Implementing a Neuropalliative Care Curriculum for Neurology Residents

View ORCID ProfileSonya Taryn Gleicher, View ORCID ProfileCaroline Jeanette Hurd, P. Annie Weisner, View ORCID ProfileAli Marisa Mendelson, View ORCID ProfileClaire J. Creutzfeldt, View ORCID ProfileBreana L. Taylor
First published November 29, 2022, DOI: https://doi.org/10.1212/NE9.0000000000200021
Sonya Taryn Gleicher
From the Department of Neurology (S.T.G., P.A.W., C.J.C., B.L.T.), Division of Geriatrics and Gerontology (C.J.H.), Department of Medicine, University of Washington; and Hospice and Palliative Care (A.M.M.), Kaiser Permanente Washington, Seattle.
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  • ORCID record for Sonya Taryn Gleicher
Caroline Jeanette Hurd
From the Department of Neurology (S.T.G., P.A.W., C.J.C., B.L.T.), Division of Geriatrics and Gerontology (C.J.H.), Department of Medicine, University of Washington; and Hospice and Palliative Care (A.M.M.), Kaiser Permanente Washington, Seattle.
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P. Annie Weisner
From the Department of Neurology (S.T.G., P.A.W., C.J.C., B.L.T.), Division of Geriatrics and Gerontology (C.J.H.), Department of Medicine, University of Washington; and Hospice and Palliative Care (A.M.M.), Kaiser Permanente Washington, Seattle.
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Ali Marisa Mendelson
From the Department of Neurology (S.T.G., P.A.W., C.J.C., B.L.T.), Division of Geriatrics and Gerontology (C.J.H.), Department of Medicine, University of Washington; and Hospice and Palliative Care (A.M.M.), Kaiser Permanente Washington, Seattle.
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Claire J. Creutzfeldt
From the Department of Neurology (S.T.G., P.A.W., C.J.C., B.L.T.), Division of Geriatrics and Gerontology (C.J.H.), Department of Medicine, University of Washington; and Hospice and Palliative Care (A.M.M.), Kaiser Permanente Washington, Seattle.
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Breana L. Taylor
From the Department of Neurology (S.T.G., P.A.W., C.J.C., B.L.T.), Division of Geriatrics and Gerontology (C.J.H.), Department of Medicine, University of Washington; and Hospice and Palliative Care (A.M.M.), Kaiser Permanente Washington, Seattle.
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Curriculum Innovations: Implementing a Neuropalliative Care Curriculum for Neurology Residents
Sonya Taryn Gleicher, Caroline Jeanette Hurd, P. Annie Weisner, Ali Marisa Mendelson, Claire J. Creutzfeldt, Breana L. Taylor
Neurol Edu Dec 2022, 1 (2) e200021; DOI: 10.1212/NE9.0000000000200021

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    Figure Longitudinal Workshop Schedule for Neuropalliative Care Curriculum With Alternating Schedule for PGY3–4 Residents

    ICU = intensive care unit; PGY = postgraduation year.

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    Table 1

    Summary of Content From Neuropalliative Care Curriculum Workshops8

    Summer session no.Content focusTeaching materialsSP encounter
    1. PGY2Family meetings in the neuro-ICU7-step family conference frameworkDiscuss preferences for life-sustaining treatment with daughter/son of an 84-y-old man with advanced dementia admitted to ICU for progressive respiratory failure
    NURSE framework
    2. PGY3/PGY4Serious illness conversations in the neurology outpatient clinicPAUSE talking mapDiscuss early goals of care with a 60-y-old man with glioblastoma who is hesitant to make decisions about intubation or resuscitation
    3. PGY3/PGY4Emergency conversations in neuropalliative careGUIDE frameworkShare serious news and discuss late goals of care with a spouse of a 45-y-old formerly healthy woman who meets criteria for brain death after intraparenchymal hemorrhage
    REMAP framework
    • Abbreviations: ICU = intensive care unit; PGY = postgraduation year; SP = simulated patient.

    • View popup
    Table 2

    Components of Summer Workshops From Neuropalliative Care Curriculum8,23

    ActivityGoalsSteps
    Introductions/ice breakerSet tone for the session
    Get to know one another
    1. Facilitator reviews agenda and provides context for the session
    2. Facilitator builds enthusiasm by bringing the curriculum close to the point of care
    3. Learners share names and personal details outside medicine
    Content reviewReinforce skills from self-directed modules1. Facilitator explains content for session
    2. Facilitator emphasizes how content could be adapted to patient/family needs
    Small group ground rules/being a good observerCreate safe space
    Ease tensions around role play
    Set expectations
    1. Learners share past experiences with role play
    2. Learners discuss ground rules, including confidentiality, constructive feedback, respect when others speak, and time-outs
    3. Facilitator explains the structure of simulated practice
    4. Facilitator explains how to be a good observer
    Simulated practiceAdapt content to clinical scenarios
    Practice communication skills
    1. Learners each have ∼15 min to practice with simulated patients or family members
    Take home pointsAnswer remaining questions
    Reinforce skills
    1. Facilitator asks group reflection questions
    2. Learners ask any remaining questions
    3. Learners write one thing they learned during that session and how they will incorporate it into their next neuropalliative encounter. Learners then share this take home point with the group
    Wrap-upRemind learners that practice continues during real clinical encounters1. Facilitator reviews the VitalTalk Tips smart phone application
    2. Facilitator explains opportunities to practice neuropalliative skills, such as family meetings and medical updates
    3. Facilitator emphasizes observed encounters and feedback forms
    • View popup
    Table 3

    Correlation Between Learning Objectives and Questionnaire Items From the Assessment of the Neuropalliative Communication Skills Curriculum

    Learning objectiveAssociated questionnaire item
    To coach residents in developing actionable skills and tools for family meetings, including sharing serious news and discussing goals of careQ1. I feel confident leading a family meeting independently for a patient with a serious neurologic illness
    Q4. I feel confident giving serious news
    To teach residents how to recognize and respond to patient and family emotionsQ2. I feel confident recognizing patient and family emotions during a family meeting
    Q3. I know how to respond to patient and family emotions during a family meeting
    To establish a common language for communicating with patients, families, and clinicians around palliative care needsQ5. I feel confident eliciting a patient's values
    Q6. I feel confident discussing end-of-life care
    To improve residents' confidence and comfort in providing neuropalliative careAll questionnaire items
    • View popup
    Table 4

    Preworkshop and Postworkshop Questionnaire Responses From the Neuropalliative Care Curriculum

    Questionnaire statementsPreworkshop responses agree or strongly agree (N = 14), n (%)Postworkshop responses agree or strongly agree (N = 12), n (%)
    Q1. I feel confident leading a family meeting independently for a patient with a serious neurologic illness8 (57.1)9 (75.0)
    Q2. I feel confident recognizing patient and family emotions during a family meeting13 (92.9)11 (91.7)
    Q3. I know how to respond to patient and family emotions during a family meeting6 (42.9)7 (58.3)
    Q4. I feel confident giving serious news9 (64.3)7 (58.3)
    Q5. I feel confident eliciting a patient's values7 (50.0)8 (66.7)
    Q6. I feel confident discussing end-of-life care7 (50.0)8 (66.7)
  • NameLocationContribution
    Sonya Taryn Gleicher, MD, EdMDepartment of Neurology, University of Washington, SeattleDrafting/revision of the manuscript for content, including medical writing for content; analysis or interpretation of data
    Caroline Jeanette Hurd, MDDepartment of Medicine, Division of Geriatrics and Gerontology, University of Washington, SeattleDrafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data; study concept or design; analysis or interpretation of data
    P. Annie Weisner, MD, PhDDepartment of Neurology, University of Washington, SeattleDrafting/revision of the manuscript for content, including medical writing for content; study concept or design
    Ali Marisa Mendelson, MDHospice and Palliative Care, Kaiser Permanente Washington, SeattleDrafting/revision of the manuscript for content, including medical writing for content; study concept or design
    Claire J. Creutzfeldt, MDDepartment of Neurology, University of Washington, SeattleDrafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data; study concept or design; analysis or interpretation of data
    Breana L. Taylor, MDDepartment of Neurology, University of Washington, SeattleDrafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data; study concept or design; analysis or interpretation of data

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