International Journal of Healthcare Simulation

Introduction:

Fourth-year medical students undertook five weeks of clinical placement in healthcare of later life (HCOLL: Geriatric and Stroke Medicine, and Old Age Psychiatry). These specialities manage older patients with complex medical and psychosocial needs, often resulting in challenging ethical dilemmas [1]. Hence, effective multidisciplinary teamwork and communication with patients and their next-of-kin (NOK) become essential in delivering person-centred care. We aimed to provide a safe environment for the participants to have in-depth discussions on some of these ethical issues, develop relevant communication skills, and better understand the roles of the Multidisciplinary Team (MDT) members in HCOLL.

Methods:

We conducted fourteen half-day sessions between August 2021 and May 2022. Each session involved small-group discussions facilitated by educators/specialists from HCOLL background. The participants were presented with four scenarios relating to the hospital admission of an older patient following an acute stroke. Their tasks included:

- Obtaining a collateral history from the NOK, which was role-played by a simulated participant. Initially the simulated participant would join the sessions via MS Teams due to COVID-19 physical distancing rules. However, since April 2022 the sessions transitioned to face-to-face encounters.

- Discussing capacity assessment and communicating Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decision to NOK.

- Discussing Advance Decision to Refuse Treatment (ADRT).

- Discussing the ethical/medico-legal issues surrounding artificial feeding including discussing feeding at risk with NOK.

- Discussing the role of the MDT in the discharge planning process and communicating discharge plans with NOK.

Results:

143 participants completed the pre- and post-workshop questionnaires. An overwhelming majority (93.5%) reported increased understanding of ethical issues and the roles of the MDT within HCOLL after the workshop and improved confidence in having difficult discussions with patients and their NOK. The DNACPR and risk-feeding scenarios stood out the most for the participants, with the majority describing it as ‘very challenging but useful.’

Conclusion:

The joint simulation workshop is an effective method of improving medical students’ understanding of the MDT and common ethical dilemmas within HCOLL as well as their confidence when addressing these issues.

Reference

1. Mueller PS, Hook CC, Fleming KC. Ethical issues in geriatrics: a guide for clinicians. Mayo Clin Proc. 2004 Apr;79(4):554–62. doi: 10.4065/79.4.554. PMID: 15065621.