GOCARE: Goals of Care Resident Ambulatory Education (S707)

Abstract

1.Understand the significance for teaching residents how to initiate advance care planning conversations for patients with complex medical illness for the outpatients.2.Describe the methods used for the GOCARE educational intervention. Good communication with a trusted physician is central to the practice of medicine, particularly for advance care planning (ACP) discussions. Medical residents frequently have these conversations in the inpatient setting but unfortunately, patients in the hospital are often too ill to participate in decision making. Although it would be preferable to have these discussions earlier, few residents conduct goals of care discussions with their patients during outpatient visits. This pilot project aims to promote the quality and quantity of these discussions by giving residents the knowledge and skills to engage in advance care planning in the outpatient setting. 1) Describe the concept of advance care planning and a framework for having these conversations. 2) Depict ways to respond to patients' emotions and emotional concerns. 3) Improve confidence in initiating and leading ACP discussions as well as eliciting patient preferences and responding to emotions. We developed a curriculum for Internal Medicine residents during their 4-week rotation in the ambulatory clinic. The course included short didactics, role-playing, and communication labs where residents could practice their communication skills in a safe and controlled environment with standardized patients. Additionally, residents had the opportunity to practice these skills after each lesson with their own continuity patients. We evaluated the objectives for the course by using pre- and post-surveys. 45 second year residents were recruited. Residents overall enjoyed the course and believed that it was “very useful.” Compared to before the course, residents felt more prepared and more confident in topics such as giving bad news, discussing treatment options, and eliciting goals (p<0.0005, effect size 0.6). Overall, participants demonstrated a substantial increase in confidence and preparedness for ACP discussions for both inpatient and outpatient settings. This study however, did not evaluate residents' overall improvement in skill level and the next phase of the intervention is to observe resident skills before and after the intervention.