• James Downar, Nancy McNaughton, Tarek Abdelhalim, Natalie Wong, Lauren Lapointe-Shaw, Dori Seccareccia, Kim Miller, Shelly Dev, Julia Ridley, Christie Lee, Lisa Richardson, Heather McDonald-Blumer, and Kerry Knickle.
• 1 Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada.
• Palliat Med. 2017 Feb 1; 31 (2): 130-139.

BackgroundCommunication skills are important when discussing goals of care and resuscitation. Few studies have evaluated the effectiveness of standardized patients for teaching medical trainees to communicate about goals of care.ObjectiveTo determine whether standardized patient simulation offers benefit over didactic sessions alone for improving skill and comfort discussing goals of care.Design And InterventionSingle-blind, randomized, controlled trial of didactic teaching plus standardized patient simulation versus didactic teaching alone.ParticipantsFirst-year internal medicine residents.Main MeasuresChanges in communication comfort and skill between baseline and 2 months post-training assessed using the Consultation and Relational Empathy measure.Key ResultsWe enrolled 94 residents over a 2-year period. Both groups reported a significant improvement in comfort when discussing goals of care with patients. There was no difference in Consultation and Relational Empathy scores following the workshop ( p = 0.79). The intervention group showed a significant increase in Consultation and Relational Empathy scores post-workshop compared with pre-workshop (35.0 vs 31.7, respectively; p = 0.048), whereas there was no improvement in Consultation and Relational Empathy scores in the control group (35.6 vs 36.0; p = 0.4). However, when the results were adjusted for baseline differences in Consultation and Relational Empathy scores in a multivariable regression analysis, group assignment was not associated with an improvement in Consultation and Relational Empathy score. Improvement in comfort scores and perception of benefit were not associated with improvements in Consultation and Relational Empathy scores.ConclusionSimulation training may improve communication skill and comfort more than didactic training alone, but there were important confounders in this study and further studies are needed to determine whether simulation is better than didactic training for this purpose.

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