To enhance neurology trainees’ comfort level in leading a goals of care conversation with a patient’s family member.

Physicians must utilize shared decision making regarding treatment options for patients with a stroke. This includes consideration of a patient’s values, as understood by their family members, to help direct treatment decisions. Currently, there is no standardized approach to educate neurology trainees on leading a goals of care conversation with patients and their family members. 

We created an objective structured clinical examination in our simulation center for graduating neurology residents. We trained a standardized professional (SP) to play the role of a patient’s family member. The learners were asked to engage in a goals of care conversation with the SP. The patient had a hemorrhagic stroke and would require the insertion of a feeding tube to sustain life. Trainees were evaluated by the SP via a written checklist on their communication skills, explanation of distinct treatment options, and ability to perform shared decision making. An observing faculty member provided verbal feedback.

Fifteen residents participated in the OSCE. All residents received full credit for utilizing non-judgmental communication. Four residents received full credit for explaining the different treatment options available to the patient in a way the SP understood.

Most residents felt well prepared for the station with a mean score of 4.125 (stdev 0.64). Most residents self-evaluated their performance to be above average with a mean score of 4 (stdev 0.53). All residents felt that the OSCE should be repeated for future classes.

OSCEs are a powerful tool to hone communication skills. Our graduating neurology residents performed well on humanistic skills, but areas for improvement included discussing technical aspects of the scenario. This OSCE can be repeated for future neurology residents to improve their ability to communicate goals of care effectively.