September 8, 2003

Quest helps Grady docs deliver hardest news

By Alicia Sands Lurry

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 style.”

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.”