End-of-Life Education in Action: Evaluating Simulation-Based Palliative Care Training for Emergency Medicine Residents

Introduction: This simulation-based curriculum aimed to improve emergency medicine residents' confidence and knowledge in applying palliative care principles in end-of-life scenarios in the emergency department. Methods: Residents participated in 4 simulation cases: (1) an elderly patient on hospice presenting with altered mental status, whose surrogate requests full intervention despite physician orders for life-sustaining treatment (POLST) indicating do not resuscitate/do not intubate and comfort-focused goals; (2) a patient with advanced dementia and hypotension, with a 2-year-old POLST indicating "Full Code," requiring reassessment of goals of care; (3) a 3-year-old in cardiac arrest after drowning with no return of spontaneous circulation; and (4) a previously healthy 12-month-old found apneic and cyanotic with persistent arrest despite prolonged resuscitation. All cases and debriefs were performed in succession and completed in 1 hour. Critical actions included leading goals-of-care discussions, interpreting advance directives, transitioning to comfort measures, and delivering death notifications. Learning objectives focused on communication skills, symptom management, and ethical and legal considerations. Learners completed pre- and postsession surveys evaluating prior experience, self-reported confidence, and knowledge of palliative principles. Results: Thirty-one residents completed both surveys. Ninety percent reported feeling more prepared to lead end-of-life discussions. Knowledge scores increased from 72.9% to 79.4%. Qualitative feedback emphasized practicing difficult conversations, clear communication at the time of death, and a desire for further training in comfort-focused care and legal frameworks. Discussion: Simulation-based end-of-life education represents an effective method for preparing emergency medicine residents for complex palliative decision-making. Findings support curricular integration.