Serious Illness Communication Training for Surgical Critical Care Fellows: A Pilot Implementation Study

Abstract

OBJECTIVE

Effective communication about serious illness is pivotal in delivering surgical palliative care—a crucial component of comprehensive surgical critical care (SCC). However, limited educational strategies exist for fellow-level trainees, who are often directing clinical decision-making and building mutual trust with patients and families. This pilot study assess implications of a novel serious illness communication training opportunity tailored specifically for SCC fellows.

DESIGN

Prospective implementation of a multimodal training session (1 hour–didactic lecture, 2 hours–live-action simulation), using pre- and postcourse surveys to assess self-perceived confidence.

SETTING

University of Michigan in Ann Arbor, Michigan.

PARTICIPANTS

Eleven ACGME-accredited SCC fellows during the 2023 to 2024 academic year participated and completed all 3 survey assessments.

RESULTS

Following the course, 6 of 7 confidence domains showed improvement, with 2 reaching statistical significance—communication skills to discuss goals of care and/or code status (3.73 vs. 4.36, p = 0.018) and end-of-life care or transition to comfort-focused care (3.36 vs. 4.18, p = 0.023) with a patient or family member. At 6-month follow up, fellows reported further increases in all queried domains, though changes were nonsignificant. Greatest absolute increases were noted in delivering serious news (4.18 vs. 4.55, p = 0.143) and expressing nonverbal empathy (4.09 vs. 4.50, p = 0.197). The majority (91%) of respondents felt more comfortable having serious illness conversations with patients and families due to their training course experience.

CONCLUSION

Implementation of a 3-hour training course tailored for SCC fellows significantly boosted both the immediate and long-term confidence in their serious illness communication skills and ability to manage complex care scenarios.