Anne-Mette Hermansen – BC Children’s Research Institute, BC, Canada Anne-Mette works at BC Children’s Hospital as a Research Coordinator with a particular interest in engaging patients and their families as partners in research about them and for them. She holds a Masters of Anthropology from The University of Victoria.
Feature Articles
Aziz, S., Hurst, S., & Marc-Aurele, K. L. (2024). Exploring the Learning Process for Neonatology Fellows of Giving Serious News on a Virtual Platform. Cureus, 16(12), e76087.
DeCourcey, D. D., Bernacki, R., Carozza, J., Lach, S., & Schwartz, A. W. (2025). Development of an Interprofessional Clinician Training in Pediatric Serious Illness Communication. Journal of Palliative Medicine.
Commentary
It is an essential practice for pediatric palliative care clinicians to communicate about issues and situations facing their patients and families. Many of these conversations are of a serious nature. Communications training, specifically training in “serious illness conversation” is important because of the deep impact the clinician’s ability to advance best practices in this work may have on the broader health outcomes of patients and families. The need for and value of training in Serious Illness Conversations as an aspect of ACP is well recognized, especially in pediatrics where clinicians are working towards shared goals of care and patient support not just for children, but their families as well. An educational focus on teaching relational and “human” skills is warranted and good programs exist to boost clinician communications skills.1,2,3
Two articles in this month’s line-up as well as the commentary by Samantha Olsen evaluate the successes of communications training, specifically as it relates to Advance Care Planning (ACP) and delivering “bad news”; one program facilitated entirely virtually and another in a hybrid format. These are two interesting examples of ways in which curricula creation and communications training can be adapted to a clinical landscape where virtual interaction is on the rise. Here we also consider what teaching content and training modalities are most effective for learners, particularly the use of simulations with a Standard Patient (SP) or trained actor, as is the case in the articles discussed in this month’s TPPCR commentary.
Aziz et. al.4 evaluates the use of a virtual platform to train neonatology fellows in giving “bad news”. The curriculum was delivered virtually, as were simulation sessions with an SP and follow up interviews with the fellows about their learning experience. The context for the use of the virtual platform was the COVID-19 pandemic in which online interactions and communications within the health sector became commonplace. Aziz et. al.’s study highlights “the potential of virtual simulations to provide a safe, comfortable, and effective learning environment for practicing challenging communication skills,” concluding that virtual teaching of essential skills may work well as a steppingstone to “higher-stakes in-person scenarios.” It is encouraging that virtual learning modalities can be successful, considering that we find ourselves in a time where they are largely inescapable in many fields. Of particular note in the context of this commentary is that the intentional use of specific virtual conferencing features, such as hiding non-video participants, allows for the creation of an intimate and “safe” learning environment.
In a feasibility study, DeCourcey et. al.5 describes the development, piloting and evaluation of the Pediatric Serious Illness Communication Program (PediSICP) as a framework for Advanced Care Planning (ACP) communications training, in a hybrid model of in-person and virtual training. The virtual training of neonatology fellows as well as the inter-professional implementation of the PediSICP make use of role play as a training modality, both studies employing a SP or trained actor to deliver this part off the training. Interestingly, feedback from both groups of learners point towards this aspect of the training as particularly valuable. One learner in the PediSICP program says: “The utilization of the actor and role play made the training more effective because we weren’t just told what to do, we were actually able to practice and work through the anxiety of having the conversations.” Feedback provided from the group of neonatology fellows revealed that the online interactions with an SP were “vital” to their learning experience. The hybrid model also allows for the program to be delivered remotely, which makes it easily scalable and accessible to a broad audience. The program is highly successful, with a 97.5% of participants satisfied with the quality of the training.
It seems that virtual modalities for delivering serious illness conversation training can successfully frame authentic, safe and productive learning spaces for clinicians honing essential skills of meeting families caringly in difficult circumstances. Particularly adding the human element of allowing learners to practice within a realistic scenario and opposite a SP proves impactful and effective. The neonatologist fellows also reflect on their previous learnings as being particularly effective when based on observation or collaboration with mentors, that have allowed them to adopt practices they have seen “in real life” to their own repertoire. I wonder if there are ways of modifying this aspect of communications training to include people with lived experience (PWLE) rather than proxies and if use of PWLE would even further augment the impact of such programs as the PediSICP. There are examples of such successful initiatives, for instance in Serious Illness Conversation training out of Canuck Place Children’s Hospice in Vancouver, Canada.6 We may need to strike a balance of possibility and feasibility in a time where virtual modalities for training and practicing such essential skills as those needed in serious illness conversations and ACP are commonplace, but perhaps it is worth our energy to think carefully about retaining a human and “real life” element of such training, to the benefit of learners.
References
- Ariadne Labs, Boston. Serious Illness Conversation Guide. Published May 2023. Accessed May 2, 2025.
- Downing J, Ling J, Benini F, et al. Core competencies for education in paediatric palliative care. Report of the EAPC children’s palliative care education taskforce. Published November 2013. Accessed May 2, 2025.
- Canadian Hospice Palliative Care Association. Advance care planning in Canada: a Pan-Canadian framework. Published January 2020. Accessed May 2, 2025.
- Aziz, S., Hurst, S., & Marc-Aurele, K. L. (2024). Exploring the Learning Process for Neonatology Fellows of Giving Serious News on a Virtual Platform. Cureus, 16(12), e76087.
- DeCourcey, D. D., Bernacki, R., Carozza, J., Lach, S., & Schwartz, A. W. (2025). Development of an Interprofessional Clinician Training in Pediatric Serious Illness Communication. Journal of Palliative Medicine.
- Breemen et. al. (Forthcoming, Palliative Medicine Reports)
View the 2025 Issue #4 Citation List in Library