Tammie Quest, assistant professor of emergency
medicine and a Project on Death in America faculty scholar, has
developed an innovative curriculum teaching emergency medicine residents
at Grady Hospital how to communicate the news of sudden death to
families in the emergency setting.
The curriculum is designed to strengthen medical residents’
interpersonal communication skills while using professionally trained
theater 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 core element of the
emergency medicine curriculum at Emory.
Quest teaches one-hour sessions once each year at Grady. Afterwards,
residents form small groups with the actors, or “standardized
survivors” as they are known, who portray different scenarios.
Residents are discourged from using medical jargon and trained to
deal compassionately with bereaved family members. They are expected
to empathize with some of the more difficult survivors, including
those who are angry and belligerent.
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,” Quest said. “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, when people
die, what do we as residents do?” she continued. “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 Quest admits there is no standard method for training residents
on how to communicate the news of death, she says it is something
that can be learned.
“This falls into the category of interpersonal skills, communication
and professionalism,” she said. “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. I get residents in the same
mindset: that this is just as procedurally oriented as the other
things they do.”
A faculty evaluator attends each scenario between the residents
and actors. The sessions generally last about 20 minutes, 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?’” Quest
said. “We like to avoid those euphemisms when we are talking
to families. Empathic behaviors and statements can 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
Overall, Quest said the course has been an overwhelming success.
“The people who participate in these sessions find it to be
an incredible learning experience,” she said. “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 we do in emergency medicine, but we
teach residents that it’s a skill they can learn to do well.”