525 - Mock No Code: A Simulation Curriculum to Increase Pediatric Trainees' Exposure to Palliative Care in Acute Clinical Scenarios

Poster Number: 525
Publication Number: 525.327

Alexa Manrriquez, Children's Hospital Los Angeles, Los Angeles, CA, United States; Hsuan-Hsiu Annie Chen, University of Hawaii, John A. Burns School of Medicine, Honolulu, HI, United States; Jennifer Greenman, Children's Hospital Los Angeles, Los Angeles, CA, United States; Chris Adrian, Children's Hospital Los Angeles, Los Angeles, CA, United States; Alyssa Rake, Johns Hopkins All Children's Hospital, St. Petersburg, FL, United States; Margaret J. Klein, Children's Hospital Los Angeles, Los Angeles, CA, United States; Gitanjli Arora, Children's Hospital Los Angeles, Los Angeles, CA, United States

Background: Pediatric residents are often frontline providers during acute resuscitation and end-of-life care. Due to limited exposure, residents often feel underprepared to care for hospitalized children at the end of life, which may result in interventions that are inconsistent with the family’s goals. In these scenarios, primary palliative care skills are critical to deliver family-centered, goal-concordant care to children. Residents may practice these skills through simulation; however, symptom management and team communication are the least addressed palliative care skills in existing simulation trainings. The Mock No Code curriculum is a simulation-based educational program designed for pediatric residents to practice and gain exposure to primary palliative care skills. Biannual sessions utilize high-fidelity simulation for facilitated, hour-long case-based sessions during which residents encounter a pediatric patient with an Advance Care Plan in an acute clinical scenario.

Objective: Develop and assess a novel simulation curriculum to expose pediatric residents to acute resuscitation and palliative care for children with Advance Care Plans.

Design/Methods: Pediatric residents were surveyed before and after participation in biannual Mock No Code sessions over a three-year period. Surveys were piloted with the palliative care team and chief residents and asked about residents’ confidence or comfort level in various aspects of care, including managing symptoms and leading end-of-life discussions. Responses were sorted for ongoing data analysis based on exposure.

Results: Of residents surveyed prior to Mock No Code exposure, 48% were uncomfortable with pain management at the end of life and 56% were uncomfortable with other symptom management. Preliminary results from the final year of data collection indicate that residents who were exposed to the curriculum report higher levels of comfort and confidence in caring for children at the end of life than those who were not exposed. We expect the final statistical analysis in early January.

Conclusion(s): The Mock No Code curriculum fills the gaps in existing palliative care simulation by utilizing high-fidelity simulation to focus on the acute care and management of children with Advance Care Plans in a team-based setting. Since its onset, Mock No Code has increased resident exposure to caring for patients with Advance Care Plans and is associated with increased resident comfort and confidence in caring for these patients in a goal-concordant manner. We plan to expand this curriculum to pediatric fellows and acute care nurses.