O5 ‘Difficult Conversation’s Course’

Emergency Medicine at times is extremely challenging for staff leading resuscitation, ethical dilemmas, end of life care, mental health patients and always has the expectation that we should be aware of the unexpected presentations yet deal with them as if this is a normal day within the workplace. The emotional toll of such scenarios can have a massive impact on those clinicians and nursing staff dealing with such events. No textbook teaches apathy. No text book teaches compassion. No textbook teaches compassion. Many complaints come from poor communication. In the most emotive days of work how can we within the ED strive to make that patients journey or relatives journey a positive experience? How can we prepare ourselves to be professional in the midst of emotion? How can our communication promote both good patient experiences but good departmental teamwork in a family’s crisis? In-situ simulation can cause difficulty as the shear emotions cannot be portrayed when simulating communication. In the Royal Victoria Emergency Department Belfast, we sought help from Queen’s University Belfast Acting Students to try and aid us to better simulation. We founded the ‘Difficult Conversations Day’. Now in its second year – we bring both senior medical and nursing teams through set seniors covering the most emotive real cases we have had in our ED. From the paediatric death, to the concealed pregnancy, the mental health aggressive patient, to the unsurvivable bleed – cases that demonstrate the need for good communication. We had double feedback – both from the actors as patients, to the staff reviewing the acting skills. This ultimately helped both parties in how we present ourselves. The students valued very honest structured feedback so if we were faced with this situation in reality, the patient experience would be improved. We numerically recorded the confidence on how well the clinician’s felt prepared for these scenarios and showed over a 40% improvement in confidence. With the clinical and nursing staff being at risk of second victims in these difficult conversations this course was supported by clinical psychology to provide support in an non-judgmental and open way. It also gave support to those whom may have been affected by these examples previously.