title: The use of standardized patients within a procedural competency model to teach death disclosure.
abstract: OBJECTIVE
  To design, implement, and evaluate a multi-dimensional, interdisciplinary, educational training module that enables residents to deliver an effective and empathic death disclosure in the emergency setting. The Accreditation Council for Graduate Medical Education (ACGME) "Toolbox of Assessment Methods" to assess competency was adopted as the foundation of this project.
  
  
  METHODS
  Sixteen emergency medicine residents, eight postgraduate year 1 (PGY-1) and eight PGY-2, underwent a one-day training and evaluation exercise. The exercise consisted of: 1) a large-group didactic session, 2) a small-group didactic session, and 3) two standardized patient (SP) examinations. Changes in comfort levels, training helpfulness, and competency were measured. Inter-rater agreement between evaluators was examined.
  
  
  RESULTS
  Trainees reported improvement in comfort levels and high levels of satisfaction regarding the helpfulness of the training. Good interrater agreement was obtained regarding resident competency to perform a death disclosure between the faculty and SP evaluators [kappa 0.61; 95% confidence interval (95% CI) = 0.33 to 0.88]. However, overall agreement among raters was poor (kappa 0.16; standard error = 0.26). This poor agreement reflected a lack of agreement between resident and SP evaluators (kappa 0.08; 95% CI = 0.16 to 0.33) and resident and faculty evaluators (kappa -0.02; 95% CI = 0.30 to 0.26).
  
  
  CONCLUSIONS
  This project used the ACGME "Toolbox of Assessment Methods" to evaluate the competency of emergency medicine trainees to perform an effective and empathic death disclosure. The finding of inconsistent competency assessments by resident self-evaluators compared with those assessments made by faculty and standardized patients have important implications in future curricular design.
authors.affiliation: Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA 30303, USA. tquest@emory.edu
authors.forename: Tammie E
authors.initials: TE
authors.lastname: Quest
authors.forename: J Alan
authors.initials: JA
authors.lastname: Otsuki
authors.forename: John
authors.initials: J
authors.lastname: Banja
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Ratcliff
authors.forename: Sheryl L
authors.initials: SL
authors.lastname: Heron
authors.forename: Nadine J
authors.initials: NJ
authors.lastname: Kaslow
mesh_terms: D003643:Death; D030881:Disclosure; D004635:Emergency Medicine / Q000193:education*; D006801:Humans; D017145:Models, Educational; D016544:Patient Simulation; D011446:Prospective Studies