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August 20, 2003


Emergency Medicine Physician Develops Curriculum Teaching Medical Residents How to Communicate News of Death to Families

ATLANTA -- Tammie E. Quest, MD, assistant professor in the Department of Emergency Medicine at the Emory University School of Medicine and Project on Death in America Faculty Scholar, has developed an innovative curriculum teaching emergency medicine residents at Grady Memorial Hospital how to communicate the news of sudden death to families in the emergency setting.

The curriculum is specifically designed to teach and strengthen medical residents’ interpersonal and communication skills, while using local, professionally trained theatre actors as standardized patients to portray grieving families. It is one of the few programs of its kind in the country to use standardized patients, and has since become a standard part of the emergency medicine curriculum at Emory.

The sessions are held once each year in a one-hour lecture format that Dr. Quest teaches at Grady Hospital. Afterwards, residents form small groups with the actors, or "standardized survivors" as they are known, who portray different scenarios. Medical jargon is not used, and residents are trained to deal with bereaved family members in a compassionate manner as they notify them about the news of sudden, unexpected deaths. Residents are taught and expected to empathize with some of the most difficult survivors, including those who are angry and belligerent.

The next session will be held on Tuesday, Sept. 2, at Grady.

Dr. Quest’s desire to start the program is based on the lack of training she experienced in her own residency training.

"I was really interested in teaching death disclosure because it was not something I learned in a formal and structured way in my residency program," Dr. Quest explains. "I found that it was one of those things where we spent a lot of time teaching advanced cardiac life support and then lots of people in the emergency department died even when advanced life support was optimally delivered. We didn’t spend any time dealing with the part of when people die, what do we as residents do, and how do we talk to bereaved families. As a teacher and educator, I wanted to figure out a way to teach that more effectively."

While Dr. Quest admits there is no set method for training residents on how to communicate the news of death, she says it is something that can be learned.

"There is no standardized, widely accepted curriculum in emergency medicine for how you teach this," she says. "This falls into the category of interpersonal skills, communication and professionalism. The concept of standardized patients is a very useful modality to teach these skills. I look at this as a procedural model, just like any other procedure you would do in the emergency department. It can do someone a lot of good, it might be difficult, and there might be complications. I get residents in the same mindset that this is as procedurally oriented as the other things they do."

Present during each scenario are the medical residents, actors, and a faculty evaluator. The interaction generally lasts about 20 minutes or so, followed by a feedback period in which faculty comments on residents’ mannerisms, such as eye contact and body language, and whether they used medical jargon to break the news of death to families.

"We evaluate the residents on whether they use the word ‘dead’ or did they say ‘your loved one passed?’" Dr. Quest says. "We like to avoid those euphemisms when we are talking to families. Empathic behaviors and statements can be learned that help deliver this very difficult news in an honest and direct manner, while still caring for the emotional and psychological needs of the survivors. The outcome measurements in our program are more about the behaviors and the words that residents use as part of their communication style."

Overall, Dr. Quest says the course has been an overwhelming success. "The people who participate in these sessions find it to be a really incredible learning experience," she says. "Often, residents evaluate themselves, and the survivors evaluate the residents, providing critical feedback they may never otherwise receive. This is one of the harder things that we do in emergency medicine, but we teach residents that this is a skill that can be learned, and it’s something they can learn to do well. The public should feel comfortable that their loved one’s doctor is as competent a communicator as they are technically sound."

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