NHS Education for Scotland Enhancing the preparedness of doctors to manage death related communications Dr Janice Turner, Principal Educator, Professional Development Dr Clare Tucker, Project Lead Grief & Bereavement
NHS Education for Scotland Scottish context 57k deaths/ year 30% unexpected
NHS Education for Scotland Background • Bereavement care/ communication core business • Poorly handled – issue safe patient care of bereaved & impact staff wellbeing • Patient safety agenda – minimising harm • Needs of bereaved influenced by situation around time of death • Training focussing purely on expected deaths not equipping doctors for range of death scenarios • Ongoing evidence medical staff feel ill prepared
NHS Education for Scotland Building the evidence base • 4 literature reviews • Bereavement education • Post-death team-based reflective practice • Staff wellbeing • Review of bereavement care standards • Understanding what is taught/ assessed – gaps? • Scoping/ mapping current training/ curricula • Stakeholder engagement • Gathering intelligence international context
NHS Education for Scotland What does the bereavement education literature say? • Low prevalence of bereavement training with corresponding high need for it • Training often ‘ diluted ’, subsumed into PEOLC • Need for a layered, tiered approach to development • Need for fully engaged educational supervision in practice to facilitate learning/ feedback • Need for both core and context specific educational interventions
NHS Education for Scotland Junior doctor survey Considering your UG training & subsequent practice, are there any areas of preparation that you feel could have been done better?
NHS Education for Scotland “Very little undergraduate training relating to bereavement. Enough training on breaking bad news but next to nothing relating to many of the important things mentioned above” “Teaching surrounding these issues was usually done in a PowerPoint/ lecture format, was a fairly formal discussion and with hindsight wasn't entirely useful/ realistic for practice.”
NHS Education for Scotland “Excellent communication training at X but could have done with actual scenarios specifically relating to death and dying”. “I feel really strongly that whilst we are taught a lot about ‘communication in difficult circumstances’…we do not get any advice or guidance as to how to care for ourselves when patients die”
NHS Education for Scotland FY survey results cont. • No access to the following in relation to communication with those who are bereaved: – simulation (80%) – case based discussion (70%) – support during consultation (32%) – feedback re.comm skills (66%)
NHS Education for Scotland FY survey results cont. • Lowest areas of preparedness: negotiating family dynamics & discussing PM • Other areas where training could be enhanced: – Clinical processes e.g. paperwork across UK countries – Managing specific discussions e.g. faith/ cultural diversity – Attention on how to talk to families not just patient interactions & dealing with anger – Observe senior colleagues/ learning revisited in later UG years – Lack personal advice on coping with death • When senior support available , clinical experiences around death reported among the most rewarding
NHS Education for Scotland Issues with current bereavement training • Only partial preparation of doctors – managing sudden vs. expected deaths – other types conversations e.g. death certification, post mortem or talking to children • Insufficient routine use of educational tools used in acquisition of other clinical skills – e.g. observation, feedback, simulation
NHS Education for Scotland Impact • Families • Professionals – Continuing their shift – Talking to other families – Own health/ wellbeing – FYs: grief 72% & stress 56% • 20% questioned career choice in medicine following a death related situation
NHS Education for Scotland Overcoming barriers to effective communication practice at times of bereavement A national teaching & Simulated practice across range of training framework settings for bereavement Observation & Feedback Debrief & team support Opportunity to improve practice/ confidence through implementation across UK • Planned launch end 2017 •
NHS Education for Scotland Framework: Key principles 1. Mapped to GMC Generic Professional Capabilities 2. Spiral, layered approach to learning - initially focus generic abilities, adding context specific abilities later 3. Aligned to learning of other clinical skills: simulation/ role play, reflective discussions, observed practice, assessment, feedback & evaluation 4. Broad topic coverage with Practitioner Mid Specialty training embedded into Training End Foundation pre-existing learning Training Undergraduate opportunities Specialty Mentorship, contexts, advise Core skills, observation, receive feedback, reflect, resilience feedback, juniors, debrief, QI teamwork
NHS Education for Scotland Structured to mirror process of communication 1. Understand e.g. – Describe how people may be affected by a bereavement immediately following a death and in the longer term and how those who are bereaved may present themselves to healthcare practitioners Explain the principles of how to complete a medical certificate of cause of death & how to sensitively discuss the content of this with a family – 2. Prepare e.g. Be aware of the broad range of types of deaths which families may experience and identify the need for different communication styles and formats depending upon the type of death and who you – will be communicating with 3. Deliver e.g. Explain how to verify a death, state what will happen to the body between death and disposal and explain how to sensitively talk to a family about both of these – Identify factors that will support the delivery of structured, safe, effective, person-centred and supportive communication around the time of a death and in bereavement for both anticipated and – unanticipated/ sudden deaths during observation of clinical situations across a range of specialty areas 4. Record e.g. Explain the appropriate layout and content for an entry into the patient’s clinical record following a peri -death/ bereavement related interaction – Complete an accurate mock MCCD, manually and (if appropriate) electronically – 5. Reflect e.g. – Explain the challenges associated with maintaining effective verbal/ non-verbal communication with those who are in emotional distress around the time of a death Recognise the importance of the continuity of care for families after a death –
NHS Education for Scotland Educational toolkit: supporting implementation • Role play/ simulation scenarios • Exam questions • Cases - individual reflection/ group discussion • Tools for debrief • Mobile app • Short animated films
NHS Education for Scotland Support around Death website www.sad.scot.nhs.uk
NHS Education for Scotland UK application • National dimension of training / trainee movement • Opportunity to improve care of the bereaved through implementation of the framework / toolkit across the UK
NHS Education for Scotland Get in touch • Examples innovative bereavement educational initiatives • Pre-existing materials for toolkit of resources • Author/ co-author new resources • Reflections on UK implementation of the framework/ toolkit • Consultation on framework to be published soon
NHS Education for Scotland Thank you clare.tucker@nes.scot.nhs.uk @NES_Bereavement www.sad.scot.nhs.uk
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