Improving Goals of Care Discussion: Innovative Curriculum Development for Internal Medicine Residents (S829)

Abstract

1.Describe the development of a communication workshop for internal medicine trainees focused on goals of care and code status discussions.2.Recognize that brief educational interventions can improve palliative care communication skills. Palliative care communication skills are applicable to all physicians regardless of specialty. All internists need to understand and develop skills to facilitate conversations that ascertain patient preferences regarding life-sustaining therapies and goals of care (GOC), particularly in the context of serious illness. Internal medicine and palliative care educators both recognize the need to further develop curriculum structures that address these communication skills. This project will assess an initiative focused on enhancing these skills. Assess the impact of a communication workshop for internal medicine trainees focused on goals of care and code status discussions. The learners consisted of internal medicine residents (n=67) at the University of Iowa during the 2017-2018 academic year. We developed and implemented a 100-minute interactive GOC communication workshop to introduce learners to the knowledge and skills of negotiating GOC and code status (CD). Multiple teaching strategies were used including pre-assigned reading material, video clips demonstrating effective GOC discussion, didactics, and facilitated role-playing led by interdisciplinary faculty. The evaluation included: 1) a standard session evaluation survey to examine learner reaction to the training; and 2) a retrospective pre/post self-assessment survey on confidence in discussing GOC. 31 residents completed the survey. Analysis of paired evaluations showed significant improvements in residents’ confidence in conducting 1) GOC discussions (p=0.0012); 2) CD discussion (p=0.03) and 3) end-of-life discussions (p=0.01). 87% found the curriculum to be useful; 97% reported that palliative care training is essential. The GOC communication workshop was successfully implemented and increased internal medicine residents’ confidence in having difficult discussions. We need to further implement such curriculum in other residency-training programs.