Standardized patient simulation versus didactic teaching alone for improving residents' communication skills when discussing goals of care and resuscitation: A randomized controlled trial.
Communication 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.



To determine whether standardized patient simulation offers benefit over didactic sessions alone for improving skill and comfort discussing goals of care.



Single-blind, randomized, controlled trial of didactic teaching plus standardized patient simulation versus didactic teaching alone.



First-year internal medicine residents.



Changes in communication comfort and skill between baseline and 2 months post-training assessed using the Consultation and Relational Empathy measure.



We 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.



Simulation 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.
1 Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada.|2 Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
James
J
Downar
3 Standardized Patient Program, University of Toronto, Toronto, ON, Canada.
Nancy
N
McNaughton
4 Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada.
Tarek
T
Abdelhalim
1 Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada.|4 Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada.
Natalie
N
Wong
4 Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada.
Lauren
L
Lapointe-Shaw
2 Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
Dori
D
Seccareccia
5 Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
Kim
K
Miller
1 Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada.
Shelly
S
Dev
2 Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
Julia
J
Ridley
1 Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada.
Christie
C
Lee
4 Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada.
Lisa
L
Richardson
4 Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada.
Heather
H
McDonald-Blumer
3 Standardized Patient Program, University of Toronto, Toronto, ON, Canada.
Kerry
K
Knickle
D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003142:Communication; D004501:Education, Medical; D004517:Education, Professional / Q000379:methods*; D004645:Empathy; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D008297:Male; D010347:Patient Care Planning; D016544:Patient Simulation; D011361:Professional Competence / Q000592:standards*; D011446:Prospective Studies; D012044:Regression Analysis; D012151:Resuscitation; D013663:Teaching
Patient simulation; communication; education; medical; patient care planning; resuscitation