title: Simulation-based end-of-life care training during surgical clerkship: assessment of skills and perceptions.
abstract: BACKGROUND
  Assessment of interpersonal and psychosocial competencies during end-of-life care training is essential. This study reports the relationship between simulation-based end-of-life care Objective Structured Clinical Examination ratings and communication skills, trust, and self-assessed empathy along with the perceptions of students regarding their training experiences.
  
  
  METHODS
  Medical students underwent simulation-based end-of-life care OSCE training that involved standardized patients who evaluated students' communication skills and physician trust with the Kalamazoo Essential Elements Communication Checklist and the Wake Forest Physician Trust Scale. Students also completed the Jefferson Scale of Physician Empathy. Pearson correlation was used to examine the relationship between OSCE performance grades and communication, trust, and empathy scores. Student comments were analyzed using the constant comparative method of analysis to identify dominant themes.
  
  
  RESULTS
  The 389 students (mean age 26.6 ± 2.8 y; 54.5% female) had OSCE grades that were positively correlated with physician trust scores (r = 0.325, P < 0.01) and communication skills (r = 0.383, P < 0.01). However, OSCE grades and self-reported empathy were not related (r = 0.021, P = 0.68). Time of clerkship differed for OSCE grade and physician trust scores; however, there was no trend identified. No differences were noted between the time of clerkship and communication skills or empathy. Overall, students perceived simulation-based end-of-life care training to be a valuable learning experience and appreciated its placement early in clinical training.
  
  
  CONCLUSIONS
  We found that simulation-based OSCE training in palliative and end-of-life care can be effectively conducted during a surgery clerkship. Moreover, the standardized patient encounters combined with the formal assessment of communication skills, physician trust, and empathy provide feedback to students at an early phase of their professional life. The positive and appreciative comments of students regarding the opportunity to practice difficult patient conversations suggest that attention to these professional characteristics and skills is a valued element of clinical training and conceivably a step toward better patient outcomes and satisfaction.
authors: Department of Surgery, Wright State University, Dayton, Ohio. Electronic address: priti.parikh@wright.edu.
authors: Priti P
authors: PP
authors: Parikh
authors: Department of Surgery, Wright State University, Dayton, Ohio.
authors: Ronald
authors: R
authors: Brown
authors: Department of Community Health, Wright State University, Dayton, Ohio.
authors: Mary
authors: M
authors: White
authors: Department of Surgery, Wright State University, Dayton, Ohio.
authors: Ronald J
authors: RJ
authors: Markert
authors: Department of College of Nursing and Health, Wright State University, Dayton, Ohio.
authors: Rosemary
authors: R
authors: Eustace
authors: Department of Surgery, Wright State University, Dayton, Ohio.
authors: Kathryn
authors: K
authors: Tchorz
mesh_terms: D000328:Adult; D002982:Clinical Clerkship; D002983:Clinical Competence; D003142:Communication; D004521:Educational Measurement; D004645:Empathy; D005260:Female; D013502:General Surgery / Q000193:education; D006801:Humans; D008297:Male; D010166:Palliative Care; D016544:Patient Simulation; D017064:Process Assessment, Health Care; D013727:Terminal Care / Q000523:psychology*; D035502:Trust; D055815:Young Adult
keywords: Empathy; End-of-life care training; Palliative training; Physician communication; Physician trust