TY - JOUR
T1 - Narrative Approach to Goals of Care Discussions
T2 - A Novel Curriculum
AU - Wu, David Shih
AU - Kern, David E.
AU - Dy, Sydney Morss
AU - Wright, Scott M.
N1 - Funding Information:
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors have no conflicts of interest to report. Dr. Wu is supported by the Hearst American Academy of Hospice and Palliative Medicine Leadership Scholars Fund. Dr. Wright is the Anne Gaines and G. Thomas Miller Professor of Medicine and supported through the Johns Hopkins Center for Innovative Medicine.
Funding Information:
This study is dedicated to the late Dr. Stuart J. Farber. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors have no conflicts of interest to report. Dr. Wu is supported by the Hearst American Academy of Hospice and Palliative Medicine Leadership Scholars Fund. Dr. Wright is the Anne Gaines and G. Thomas Miller Professor of Medicine and supported through the Johns Hopkins Center for Innovative Medicine. The authors are indebted to Will Bevins, MDiv, MA; Anna Diller, MD, MPH, MBA; Linda Gorman, MLS; Rev. Peter Heikkinen, MDiv; Erica Leonard, MD; Lingsheng Li, MD, MHS; Jane Schindler, LCSW-C, APHSW-C; and Seonho Shin, PhD, for their help and guidance.
Publisher Copyright:
© 2019 American Academy of Hospice and Palliative Medicine
PY - 2019/12
Y1 - 2019/12
N2 - Context: Innovative patient-centered approaches to goals of care (GOC) communication training are needed. Teaching a narrative approach, centered on the patient's unique story, is conceptually sound but has not been evaluated with respect to objective skills attainment. We developed a curriculum based on a novel, easily-remembered narrative approach to GOC, the 3-Act Model, and piloted it with a cohort of internal medicine (IM) interns. Objectives: To describe the development of the 3-Act Model curriculum and to assess its impact on the GOC communication skills of IM interns. Methods: The curriculum was developed with input from multidisciplinary experts, IM residents, and patient/family representative. Notable elements included instrument development with validity evidence established, determination of proficiency standards, and creation of role-play scenarios. In two three-hour workshops, interns participated in role-plays as both providers and patients, before and after teaching (which included narrative reflection, didactics, and video demonstration). Results: 22 interns played the role of provider in five unique scenarios; 106 proficiency ratings were analyzable. Interns objectively rated as proficient increased from 30% (pretest) to 100% (final role-play). By the end of the training, 96% of interns strongly agreed or agreed that they felt ready to independently lead basic GOC discussions and the percentage who strongly agreed increased with successive role-plays. All interns indicated they would recommend the training. Conclusion: This pilot demonstrates that the 3-Act Model is teachable and appreciated by learners. This GOC curriculum is the first based on a narrative approach to demonstrate objective skills improvement.
AB - Context: Innovative patient-centered approaches to goals of care (GOC) communication training are needed. Teaching a narrative approach, centered on the patient's unique story, is conceptually sound but has not been evaluated with respect to objective skills attainment. We developed a curriculum based on a novel, easily-remembered narrative approach to GOC, the 3-Act Model, and piloted it with a cohort of internal medicine (IM) interns. Objectives: To describe the development of the 3-Act Model curriculum and to assess its impact on the GOC communication skills of IM interns. Methods: The curriculum was developed with input from multidisciplinary experts, IM residents, and patient/family representative. Notable elements included instrument development with validity evidence established, determination of proficiency standards, and creation of role-play scenarios. In two three-hour workshops, interns participated in role-plays as both providers and patients, before and after teaching (which included narrative reflection, didactics, and video demonstration). Results: 22 interns played the role of provider in five unique scenarios; 106 proficiency ratings were analyzable. Interns objectively rated as proficient increased from 30% (pretest) to 100% (final role-play). By the end of the training, 96% of interns strongly agreed or agreed that they felt ready to independently lead basic GOC discussions and the percentage who strongly agreed increased with successive role-plays. All interns indicated they would recommend the training. Conclusion: This pilot demonstrates that the 3-Act Model is teachable and appreciated by learners. This GOC curriculum is the first based on a narrative approach to demonstrate objective skills improvement.
KW - Communication skills curriculum
KW - assessment tool
KW - graduate medical education
KW - narrative medicine
KW - primary palliative care
KW - role-play learning
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U2 - 10.1016/j.jpainsymman.2019.08.023
DO - 10.1016/j.jpainsymman.2019.08.023
M3 - Article
C2 - 31472275
AN - SCOPUS:85072556885
SN - 0885-3924
VL - 58
SP - 1033-1039.e1
JO - Journal of Pain and Symptom Management
JF - Journal of Pain and Symptom Management
IS - 6
ER -