Mock No Code: A Simulation Curriculum for Responding to Patients With Varying Goals of Care

Area of Science:

• Pediatric critical care medicine
• Medical education
• Palliative care

Background:

• Pediatric residents require robust training in end-of-life care, including advance care plans (ACP) and symptom management.
• Current training in primary palliative care for pediatric residents is often inadequate.
• Simulation-based training, like Mock Code, offers a controlled environment for practicing high-stakes clinical skills.

Purpose of the Study:

• To enhance pediatric residents' comfort and confidence in managing resuscitation and communication for children with life-limiting illnesses and ACPs.
• To evaluate the effectiveness of a novel Mock No Code curriculum in improving palliative care skills.

Main Methods:

• A cohort study compared pediatric residents exposed to the Mock No Code curriculum with those not exposed.
• Data were collected via Likert-style surveys assessing comfort and confidence in managing patients with limitations on life-prolonging interventions.
• The study period spanned from April 2019 to September 2022 at a single institution.

Main Results:

• 151 residents completed the survey (105 exposed, 46 unexposed).
• Exposure to the Mock No Code curriculum was significantly associated with increased comfort and confidence.
• Residents demonstrated improved ability to interpret and follow ACPs during critical events.

Conclusions:

• The Mock No Code curriculum effectively enhances pediatric residents' comfort and confidence in end-of-life care.
• This simulation-based approach better prepares residents for acute clinical scenarios involving diverse goals of care.
• The curriculum addresses a critical gap in palliative care education for pediatric residents.