To describe the multi-center implementation and impact of a simulation curriculum designed to train neurology residents on communicating the diagnosis of functional neurological disorder (FND).

Delivering the diagnosis of FND is a form of high-stakes communication given historical stigma surrounding the condition and the critical role of a clearly explained diagnosis in effective treatment. High quality diagnostic disclosure is a key skill for neurology residents and should be practiced with opportunity for structured feedback.

Neurology residents at three clinical sites rotated through three simulation scenarios in which they were provided a case history and asked to share the diagnosis of FND with standardized patients (SPs). Participants completed pre and post simulation surveys assessing experience and comfort in delivering this diagnosis. Residents rotated through the scenarios, both delivering the diagnosis and observing their peers. Residents received feedback from SPs, peer observers, and faculty or fellow evaluators. Descriptive statistics and Wilcoxon signed-rank tests were used to analyze quantitative data. Learning points were characterized qualitatively.

Forty neurology residents participated in the simulation. Resident comfort delivering the FND diagnosis was significantly increased after simulation completion (p < .001). 92.5% of respondents “agreed” or “strongly agreed” with feeling better equipped to deliver the diagnosis after the simulation. Open response learning points revealed themes which included diagnostic framing (developing a ‘roadmap’ for diagnostic disclosure, naming the diagnosis, providing the diagnostic rationale), the importance of patient-centered communication (normalizing and validating the patient experience), and the generative effect of repeated experience (the value of practicing and observing others  through multiple encounters, developing an FND explanation toolkit).

A simulation-based curriculum designed to train residents in communicating the diagnosis of FND is feasible to implement across multiple clinical sites and results in increased trainee comfort. Future directions include longitudinal follow up assessing application of learned skills in clinical practice.