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
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."