Teaching Death Disclosure: A Mixed-Method Comparison of Resident Self-Assessment and Standardized Patient Assessment

Abstract

Objective: To characterize how pediatric resident self-evaluation compares to standardized patient evaluations in simulated child death disclosure scenarios.

Methods: This was a prospective, observational, mixed-methods study in which 18 second-year pediatric residents delivered the news of a death of a child to a trained standardized patient (SP) couple. The SPs evaluated residents via a quantitative global rating (1-3 scale) and via qualitative comments. Following the training, the residents completed self-assessments consisting of a global rating, qualitative comments, and their confidence related to 5 death disclosure skills.

Results: Agreement between SPs and resident ratings was poor; resident scores were compared to each of their 2 SP evaluators yielding Kappa coefficients of -0.23 (95% confidence interval = -0.60 to -0.07) and -0.30 (95% confidence interval = -0.70 to -0.04). Residents uniformly rated themselves as less capable in their communication skills than SPs did. Residents reported significant increases in their confidence in discussing autopsy and organ donation. Major themes determined from the qualitative comments from SPs included nonverbal communication, verbal communication, attunement to parents, and management of next steps. Residents' comments mirrored these themes with the exception of the absence of nonverbal communication.

Conclusions: Pediatric residents underestimated their abilities in a self-assessment of their performance in a SP death disclosure scenario, demonstrating the importance of external feedback, particularly from SPs themselves. Based on SP feedback, future death disclosure trainings should emphasize nonverbal communication skills and specific behaviors that convey effective attunement to families.

Keywords: communication; end of life issues; pediatric death; professionalism; resident education; standardized patients; teaching.