Presented By: Jennifer Van Swol, The University of Chicago
Co-Authors: Jean Clore, University of Illinois College of Medicine at Peoria
Daniel Henley, University of Illinois College of Medicine at Peoria
Michelle Rusch, University of Illinois College of Medicine at Peoria
Ann Willemsen-Dunlap, Jump Simulation and Education Center
Melissa Williams, University of Illinois College of Medicine at Peoria

Purpose
Healthcare providers regularly engage in difficult conversations with patients and families. De-escalation training can help reduce safety risks by equipping providers with tools to anticipate and respond to agitation and aggression. This pilot study evaluated the effectiveness of verbal de-escalation training delivered through simulation (involving standardized participants [SPs]) to improve situation awareness (SA), identification of future worries for the patient, and de-escalation skills of first year resident physicians (interns). 

Methods 
Pediatrics (n=11) and Med-Peds (n=1) interns attended a workshop to learn about 10 de-escalation domains before completing two simulated encounters. Part one involved interacting with a guardian resistant to admitting their child because of previous negative hospital experiences. In part two, the admitted child developed medical complications. Assessments included SA (including future worries) in addition to facilitator and SP ratings. 

Results 
SP communication ratings (max=32) in part one (mean=21.4, SD=4.0) were comparable to part two (mean=21.7, SD=2.7). Facilitator ratings in part one (mean=4.7, SD=2.3, min=1, max=8) were higher (p<0.05) than part two (mean=3.3, SD=2.6, min=1, max=7). SA results were limited by facilitator and SP training. For SA in part two, 50% of interns correctly identified items in the physical environment (SD=1.1) and 42% accurately recognized escalation behaviors (SD=0.9). Reports of future worries could be categorized into multiple themes including patient harm, guardian escalation, and concerns related to provider fear. 

Conclusions 
Despite standardized de-escalation training beforehand, there were a number of inaccuracies in SA scores, suggesting a need for additional training. Preliminary examination of reported future worries identified safety issues, personal insecurities, and legitimate patient care concerns. Findings can be used to tailor future de-escalation training to address interns' perceived deficits including managing safety concerns in addition to combating fear of reprisal and imposter syndrome.