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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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Summer session no. Content focus Teaching materials SP encounter 1. PGY2 Family meetings in the neuro-ICU 7-step family conference framework Discuss 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/PGY4 Serious illness conversations in the neurology outpatient clinic PAUSE talking map Discuss early goals of care with a 60-y-old man with glioblastoma who is hesitant to make decisions about intubation or resuscitation 3. PGY3/PGY4 Emergency conversations in neuropalliative care GUIDE framework Share 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.
Activity Goals Steps Introductions/ice breaker Set tone for the session
Get to know one another1. 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 medicineContent review Reinforce skills from self-directed modules 1. Facilitator explains content for session
2. Facilitator emphasizes how content could be adapted to patient/family needsSmall group ground rules/being a good observer Create safe space
Ease tensions around role play
Set expectations1. 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 observerSimulated practice Adapt content to clinical scenarios
Practice communication skills1. Learners each have ∼15 min to practice with simulated patients or family members Take home points Answer remaining questions
Reinforce skills1. 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 groupWrap-up Remind learners that practice continues during real clinical encounters 1. 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- Table 3
Correlation Between Learning Objectives and Questionnaire Items From the Assessment of the Neuropalliative Communication Skills Curriculum
Learning objective Associated questionnaire item To coach residents in developing actionable skills and tools for family meetings, including sharing serious news and discussing goals of care Q1. I feel confident leading a family meeting independently for a patient with a serious neurologic illness
Q4. I feel confident giving serious newsTo teach residents how to recognize and respond to patient and family emotions Q2. 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 meetingTo establish a common language for communicating with patients, families, and clinicians around palliative care needs Q5. I feel confident eliciting a patient's values
Q6. I feel confident discussing end-of-life careTo improve residents' confidence and comfort in providing neuropalliative care All questionnaire items - Table 4
Preworkshop and Postworkshop Questionnaire Responses From the Neuropalliative Care Curriculum
Questionnaire statements Preworkshop 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 illness 8 (57.1) 9 (75.0) Q2. I feel confident recognizing patient and family emotions during a family meeting 13 (92.9) 11 (91.7) Q3. I know how to respond to patient and family emotions during a family meeting 6 (42.9) 7 (58.3) Q4. I feel confident giving serious news 9 (64.3) 7 (58.3) Q5. I feel confident eliciting a patient's values 7 (50.0) 8 (66.7) Q6. I feel confident discussing end-of-life care 7 (50.0) 8 (66.7) Name Location Contribution Sonya Taryn Gleicher, MD, EdM Department of Neurology, University of Washington, Seattle Drafting/revision of the manuscript for content, including medical writing for content; analysis or interpretation of data Caroline Jeanette Hurd, MD Department of Medicine, Division of Geriatrics and Gerontology, University of Washington, Seattle Drafting/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, PhD Department of Neurology, University of Washington, Seattle Drafting/revision of the manuscript for content, including medical writing for content; study concept or design Ali Marisa Mendelson, MD Hospice and Palliative Care, Kaiser Permanente Washington, Seattle Drafting/revision of the manuscript for content, including medical writing for content; study concept or design Claire J. Creutzfeldt, MD Department of Neurology, University of Washington, Seattle Drafting/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, MD Department of Neurology, University of Washington, Seattle Drafting/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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