©EndoLSim™An innovative method for teaching end of life care to professional groups through high-fidelity simulation.


When did you first introduce the innovation?

More than 24 months ago

Please describe the innovation you have developed

©EndoLSim focuses on teaching health professionals about the care needs of patients and families in the final days and hours of life. This innovation facilitates the exploration of the often difficult issues that can arise around communication and decision making when a patient is dying. Students are expected to use their skills in empathy and compassion in this situation.

The scenario enables participants to explore the theory and practice of holistic End of Life Care (EOLC) simultaneously rather than fragmented across a disparate series of traditional lectures and seminars. This immersive and experiential approach occurs in real-time, reflecting the final stages of a patient’s life. Participants contribute to their own and their peers learning by exploration and discussion of their own experiences of involvement in EoLC.

The scenario comprises a mix of realistic, real-time physiological feedback from the highly advanced human patient simulators combined with a simulated relative (standardised actor) at the bedside of the patient.

What prompted you to develop this innovation?

This innovative teaching method is in response to the highlighted lack of EOLC teaching in pre and post-registration curricula discussed in academic literature (Bassah, Seymour & Cox, 2014). There is even less evidence of using simulated, experiential approaches in EOLC teaching across the UK. In addition to this, the numerous national policy documents in response to public dissatisfaction with EOLC, necessitates the need to address these issues at early and on-going stages of health professional learning.

©EndoLSim is aligned with the NICE Quality Standards for End of Life Care (2011) and builds on the recent review of the Liverpool Care Pathway ‘More Care, Less Pathway’ (DH, 2013). It stresses the importance of effective communication and compassionate care as highlighted in the newly established five principles of end of life care (‘One Chance to Get it Right’, Leadership Alliance for the Care of Dying People, 2014).

In your view, what is it about this innovation that makes it different/important?

This innovation is unique and important because:

  • There are few UK Simulation centres offering EOL scenarios;
  • Most simulation scenarios focus on highly technical clinical situations, whereas ©EndoLSim blends this with approaches to communication, demonstration of compassion and exploration of the psychological impact of this care on the patient, family and practitioner;
  • This simulation scenario runs in ‘real-time’ which allows the students to engage fully in the patient/family narrative and react as they would in clinical practice;
  • This scenario can be adapted and has been used with a range of ages of patients – neonate, child, adolescent and adult. The scenario setting can be ward, hospice or community focused.
  • The scenario provides a safe environment for students to explore challenging clinical scenarios prior to experiencing them in the practice setting. In addition, more experienced students/registered professionals can generate their own scenarios and utilise their current knowledge and experiences;
  • This innovation includes a continuous debriefing throughout the simulation, whereas, traditional simulation debrief occurs only at the end of the simulation. ©EndoLSim therefore highlights areas of learning and reflection as they arise creating a student focused/led learning experience.

To what degree has this innovation led to changes in education or clinical practice?

We have module evaluations from six cohorts of pre-registation students, alongside evaluation from post-registration and post-graduate students who have experienced ©EndoLSim. These evaluations consistently highlight the positive impact of ©EndoLSim on levels of perceived competence and confidence in relation to knowledge and skills in EOLC.

Students cite being more competent and confident in:

  • opening and maintaining conversations around EOLC;
  • supportive role in breaking bad news;
  • handling patient and family member’s emotions;
  • assessing and caring for patients’ spiritual needs;
  • knowledge regarding symptom control;
  • reflecting on their own psychological and emotional needs in relation to caring for patients and families at the end of life;
  • direct application of clinical end of life tools, such as advanced care planning, Do Not Resuscitate protocols and withdrawing/withholding treatment.

What evidence do you have of the impact of the innovation?

In addition to the above, students have consistently highlighted in end of programme review, the need for more simulated learning in EOLC. There are high levels of satisfaction with this approach.

To what degree has the innovation been disseminated in your organisation or elsewhere?

This innovation has been disseminated in a number of ways:

  • A trade-marked, copyrighted (©EndoLSim™) teaching and learning package has been developed for use by any organisation or group of health care professionals at no cost to external users;
  • This innovation has been presented at an International High-Fidelity Simulation Conference and a National Symposia on End of Life;
  • Key stakeholders from three regional partner organisations have engaged in discussions regarding using this innovation within their tertiary care provider settings;
  • A systematic review of the nature of EOLC high fidelity simulation is under review at a peer-reviewed journal;
  • Dissemination of this innovation has been supported by use of social media for wide exposure using #EndoLSim. This has prompted interest throughout the UK from care providers and educational organisations.

Please provide details of any plans you have to disseminate the innovation in the future.

A further paper is being written, building on on the systematic review, focusing specifically about the innovation.

It is intended to formally evaluate ©EndoLSim and disseminate the findings to validate the credibility of this approach.