Improving junior doctors’ skills and confidence
29th January 2018
Dr Katherine Sleeman at the Cicely Saunders Institute has won funding from Royal Marsden Partners to evaluate a novel educational intervention to improve junior doctors’ skills and confidence in conducting end of life conversations.
The dramatic increase in the older population and the multiple health and other problems of ageing will put great pressure on healthcare providers in the future, and many more people will need palliative care and support to help them live as well as possible until they die.
Yet palliative care teams and hospices make up a very small part of the healthcare system. In the UK, there are only approximately 3,000 hospice or palliative care beds, yet around 70-80% of the 500,000 people who die every year (and this rate is due to increase by 17% by 2030) do so after a period of decline and deterioration requiring palliative care.
Advance care planning, personalised to patients’ needs and priorities, is the cornerstone of good end of life care. However, inadequate clinician communication skills and a reluctance to initiate conversations about death can lead to the failure of end of life care planning, and is frequently the focus of NHS complaints.
All junior doctors, irrespective of their specialty, will care for patients who die. However, junior doctors report reduced confidence in end of life communication, particularly managing distress and social issues, and can be reluctant to seek support from senior colleagues. Improving junior doctors’ skills in end of life communication would help ensure patients’ preferences and priorities are met, while improving satisfaction for doctors.
The Second Conversation project is a novel teaching intervention currently being piloted in three London NHS Trusts.
The Second Conversation model is a three-stage intervention: (i) observation by a junior doctor of an initial senior-led end of life conversation followed by debrief, and preparation for; (ii) the Second Conversation which occurs soon afterwards, and is led by the junior doctor; (iii) subsequent facilitated reflection and feedback with senior colleague.
Dr Katherine Sleeman said “I am delighted to have won funding from Royal Marsden Partners to evaluate the Second Conversation model of improving junior doctors’ communication skills. Isolated educational programmes may be effective, but often lack sustainability and reach. Through built-in observation, experiential learning, feedback and reflection, the Second Conversation model offers a practical means of improving doctors’ skills in end of life communication at an early stage in their careers.
Our research will explore in more depth the acceptability of the Second Conversation with patients, carers, and staff, and examine its effectiveness. Most excitingly, the Second Conversation project has the potential to be implemented at scale, and within a short time frame, leading to benefits for patients, carers and the NHS.”