P3D127: Assessing Emergency Medicine Resident Comfort and Perceived Competence in Disclosing Concerns of Child Abuse

Background: Child physical abuse patients are frequently encountered by emergency medicine (EM) providers. When non-accidental trauma (NAT) is suspected, physicians are mandated reporters to their local child protection agency. It is important for the provider to discuss concern for NAT. This can be a difficult conversation with many similarities to breaking bad news. Considering this similarity, the SPIKES protocol for breaking bad news can provide a framework. Simulation-based practice has been shown to improve participant-perceived competence in communication skills in having difficult conversations (Tobler et al. 2014). EM residents receive little formal teaching on this conversation, and there is a gap in the literature related to education surrounding this conversation. The purpose of this study is to assess EM resident physician comfort and perceived competence regarding disclosure conversation before and after a didactic and simulation-based educational session.

Methods: A taskforce of pediatric emergency medicine (PEM) and EM clinician educators, including those with expertise in simulation and child abuse, developed a one-hour curriculum for an EM resident didactic block. The curriculum included a brief didactic session, pre-recorded model case, two simulation cases with SPs, and debrief. The simulation cases were piloted with PEM fellows prior to the educational session. This study is a prospective survey of resident physicians. Resident physicians completed a pre/post-curricular survey after completing the one-hour educational session. Pre/post-session data will be analyzed using a student’s t- test. Resident physicians also participated in a post-session group discussion, and qualitative themes were identified.

Results: Preliminary data is currently available from the first of three data collection sessions (n=8), and, once all data is collected, pre/post-survey data will be analyzed. Preliminary data shows that prior to this educational session, 87.5% of participating EM resident physicians had training in "breaking bad news,” and 12.5% had didactic training pertaining to the non-accidental trauma disclosure conversation. None of residents reported prior opportunity to practice the disclosure conversation in a simulated setting. Preliminary pre/post-survey Likert scale data indicates improved resident confidence and perceived competence in discussing concern for non-accidental trauma. Qualitative themes emerged from the first group discussion, and residents reported the didactic, model case and simulated portion were all helpful, specifically in providing the opportunity to practice and helping them frame the conversation.

Conclusion: Preliminary data suggests that most EM residents had prior formal/didactic training in breaking bad news, but few had prior didactic training in regard to the non-accidental trauma disclosure conversation. It is evident there is a need for education regarding the disclosure conversation. This educational curriculum was established to fill a gap in resident education, and preliminary data suggests that the didactic session, model conversation, and simulation cases with SPs were effective in improving resident reported confidence and comfort with the non-accidental trauma disclosure conversation.