P2C112: Teaching Consultation in the Grey Zone: A Novel Interdisciplinary Curriculum

Background: Counseling parents facing delivery at 22 0/7 – 24 6/7 weeks gestation is among the most challenging situations Neonatologists and Obstetricians face. This counseling requires a delicate balance of medical knowledge, complex communication skills, and shared decision making. Yet, most neonatology and obstetric trainees report leaving training without formal education and with low confidence in these consultation skills. Evidenced based communication curricula are urgently needed in this content area.

Methods: In this mixed methods education study, we designed and evaluated a novel counseling curriculum for neonatology and obstetric trainees. The curriculum combines small group didactics, consultation simulations, and reflective debriefing of real-life consultation experiences. Curricular elements are designed as one-hour interventions to provide flexibility for integration into varied fellowship curricula and repeated exposure. Primary outcome measures include self-assessment of trainee confidence and curricular satisfaction assessed through both questionnaires and semi-structured interviews. Secondary outcome measures include family centered communication as measured by time “parents” (rather than physicians) speak, the number of “parent” questions, and the number of physicians’ shared decision making and empathetic statements. Secondary outcomes are assessed using review of simulation videos.

Results: This abstract presents our initial needs assessment; analysis on primary and secondary outcomes is ongoing. Fifteen neonatology fellows and 6 maternal-fetal medicine doctors participated in the curriculum. Participants completed 45 simulations over an eight-month time span with a median of 2 simulations per participant. The majority of participants (75%) reported leading at least one “periviable consultation” in their clinical practice in the three months preceding the curriculum. All participants reported previous communication skills training. In spite of this clinical practice and prior education, no participants reported feeling “extremely confident” conducting “periviable consultation” prior to curriculum initiation. Participants reported lack of confidence in discussing treatment options (61%), exploring emotions of families (40%), and discussing religious beliefs/spiritual values (39%). In qualitative analysis of pre-curriculum attitudes, participants’ lack of confidence centered around themes of information transfer (outcomes knowledge, treatment explanations), navigating emotions (invoking emotions, responding to emotions), and decision regret (“being overly hopeful”, “saying something wrong that leads the family to make a decision they otherwise would not have”). All participants (100%) identified ability to express empathy as a pre-curricular area of confidence. Analysis of post-curricular participant confidence, participant satisfaction, and changes in family centered communication are currently ongoing.

Conclusion: Our initial needs assessment demonstrated obstetric and neonatology trainees’ lack of confidence in performing consultation for families at risk of delivery at 22 to 24 weeks gestation. It further characterized the areas of greatest perceived need – outcomes knowledge, description of treatment options, and exploration of family emotions– and the moral distress incurred by these consultations. Analysis of our novel curricula will help to inform urgently needed evidence-based teaching of these complex consultation skills.