Emergencies in palliative medicine: novel simulation-based curriculum for end-of-life crises and symptom management

Hospice and palliative medicine (HPM) simulation training primarily focuses on communication skills, rather than symptom management. Simulation can be an effective educational tool in high stakes clinical settings and provides a safe environment to improve skills in crisis management. HPM providers are often called to manage refractory symptoms in emotionally charged situations, especially at end-of-life care. These scenarios may present infrequently during their 1-year fellowship training. We describe a novel two-part simulation series ‘End of Life Symptom Management: Emergencies in Palliative Medicine’ that we have developed for our interdisciplinary HPM Fellowship. Our simulation series is conducted at our institution’s simulation centre and includes scenarios of (1) refractory pain, (2) palliative sedation, (3) initiation of buprenorphine-naloxone for cancer-associated pain in a patient with opioid use disorder (OUD), (4) acute pain crisis in a hospice patient with OUD on buprenorphine-naloxone, (5) terminal delirium, (6) compassionate extubation/respiratory distress, (7) status epilepticus and (8) terminal haemorrhage. Pre and postsession data collected from our HPM fellows reflect an increase in confidence levels after participating in the sessions. This simulation curriculum has allowed our fellows the opportunity to encounter and navigate these scenarios in a safe and controlled learning environment before encountering them in practice.