Communication-Focused Simulation to Enhance Paediatric Trainee Confidence in Difficult Conversations

Abstract

Objective: To design, deliver and evaluate the impact of a trainee-led simulation programme focused on paediatric communication skills, addressing an identified gap in experiential training for difficult conversations.

Background: Simulation training is a core component of paediatric education, commonly used to rehearse emergency and technical scenarios. In contrast, communication skills are often learned opportunistically despite being fundamental to safe and compassionate paediatric practice. Trainees frequently report limited confidence in

these situations. We developed a series of communication-focused simulation sessions, to provide a safe environment in which trainees could practise, observe and reflect on challenging interactions.

Methods: We delivered a series of trainee-led simulation sessions for mixed-grade learners. Each session involved 10–20 participants and lasted one hour in protected teaching time. Sessions involved pre-planned scenarios with detailed patient backgrounds and discussion points. Example scenarios included breaking bad news in the context of a new brain cancer diagnosis, explaining the importance of antibiotics to a mother who was not consenting to treatment for her septic baby and managing a disclosure of sexual abuse for a teenager presenting with non-specific symptoms.

An SHO initiated with registrar support introduced part-way through. Sessions were facilitated by senior trainees and incorporated individual reflection, feedback from the actor, peer feedback and facilitated group discussion. Participants were invited to actively take part or observe. Written feedback was collected anonymously following sessions via online forms.

Results: 80% of respondents reported increased confidence in managing challenging communication scenarios after attending the simulation, highlighting facilitation quality, safety and the value of structured debriefing. One participant reported feeling “grateful my first experience of this was a simulation rather than real life,” while others described the sessions as providing “practical and detailed advice” for breaking bad news.

Observers also reported significant learning, noting improved understanding of how to approach difficult conversations. Facilitation style and psychological safety were repeatedly cited as strengths, with structured feedback and debriefing described as the most valuable component, with one participant commenting that the feedback was “the best part of the sim.”

Conclusion: Communication-focused simulation is a valuable and underutilised educational tool in paediatric training. Our trainee-led programme is low cost, reproducible, and demonstrates that well structured scenarios with skilled facilitation and reflective debriefing, can improve confidence and preparedness for challenging clinical conversations. Incorporating communication focused simulation, alongside traditional emergency training, equips paediatric trainees for the realities of clinical practice and ultimately enhances patient and family care.