"This is a decision you have to make": using simulation to study prenatal counseling

Area of Science:

• Neonatology
• Medical Education
• Bioethics

Background:

• Prenatal decision-making during extremely preterm labor presents significant challenges for parents and physicians.
• Ethical and logistical issues have limited empirical data on physician counseling in this critical setting.
• Opportunities for communication training in neonatal care are restricted.

Purpose of the Study:

• To examine the utility of simulation in engaging neonatologists to reflect on their prenatal counseling behaviors.
• To assess the realism and counseling dynamics within a simulated extremely preterm labor scenario.

Main Methods:

• Neonatology physicians counseled standardized patients simulating a delivery at 23 3/7 weeks gestation.
• Encounters were videotaped, followed by physician surveys and debriefing interviews.
• Mixed-methods analysis evaluated clinical verisimilitude and counseling behaviors.

Main Results:

• The simulation was highly realistic, with physician behaviors aligning with self-reports from other studies.
• Physicians dominated dialogue, focusing primarily on biomedical information, yet dedicated significant time to relationship-building and empathy.
• While discussing quality of life, physicians rarely elicited parental goals; decision-making responsibility varied, and treatment recommendations were often declined.

Conclusions:

• Simulation accurately replicates the complex decision-making context of prenatal counseling for extremely preterm labor.
• Findings underscore the potential of simulation for communication training, particularly for physicians and patients needing to discuss acute diagnoses and make critical decisions without prior relationships.