Department of Medicine; Department of Family Medicine and Community Health
Health Communication | Health Services Administration | Internal Medicine | Medical Education | Palliative Care
Introduction: Goals-of-care (GOC) conversations are essential to ensure high-quality care for people with serious illness. We developed a simulation experience to train internal medicine residents in GOC conversations near end of life, followed by a real-life GOC conversation as a Mini-Clinical Evaluation Exercise (Mini-CEX) including direct feedback from participating patients.
Methods: The 3-hour simulation session trained teams of two learners each to interact with standardized patients portraying a patient with end-stage heart failure and an accompanying family member. Residents completed pre- and postsurveys regarding their self-assessed abilities and confidence in conducting these conversations. Piloted in 2016, the Mini-CEX was completed in 2017 with 28 residents 3-9 months after simulation. Patients and participating family members were invited to complete an optional, deidentified survey of their experience.
Results: From 2015 to 2017, 84 residents completed simulation training. Ninety percent of postsurvey responders felt more prepared to conduct GOC conversations after simulation compared to 42% before training. Eighty percent or more reported confidence in discussing GOC (previously 67%), prognosis (previously 62%), and hospice (previously 49%). Analysis of Mini-CEX scores revealed that the majority of residents' skills were the same or improved compared with their performance in simulation; more than 70% demonstrated improvement in ensuring patients' comfort, displaying empathy, and recognizing/responding to emotion. Almost all patients and families reported feeling heard and satisfied with their conversation with the resident.
Discussion: This curriculum was well received, and initial data support its effectiveness in enhancing residents' self-perceived confidence and interpersonal skills in real-world patient encounters.
Clinical Skills Assessment/OSCEs, Clinical Teaching/Bedside Teaching, Communication Skills, Goals-of-Care Conversations, Hospice, Hospice & Palliative Medicine, Internal Medicine, Palliative Care, Simulation
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Copyright © 2021 Nagpal et al. This is an open-access publication distributed under the terms of the Creative Commons Attribution-NonCommercial license.
DOI of Published Version
Nagpal V, Philbin M, Yazdani M, Veerreddy P, Fish D, Reidy J. Effective Goals-of-Care Conversations: From Skills Training to Bedside. MedEdPORTAL. 2021 Mar 10;17:11122. doi: 10.15766/mep_2374-8265.11122. PMID: 33768153; PMCID: PMC7970639. Link to article on publisher's site
MedEdPORTAL : the journal of teaching and learning resources
Nagpal V, Philbin M, Yazdani M, Veerreddy P, Fish D, Reidy J. (2021). Effective Goals-of-Care Conversations: From Skills Training to Bedside. Open Access Publications by UMMS Authors. https://doi.org/10.15766/mep_2374-8265.11122. Retrieved from https://escholarship.umassmed.edu/oapubs/4647
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This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License