Improving Trainees' Confidence and Participation in Serious Illness Communication: Testing the Serious Illness Care Program With Early Learners.

Abstract

Purpose: Early conversations about patients’ goals and values improve care, but clinicians struggle to conduct them. 1 The systems-based Serious Illness Care Program (SICP) 2 helps clinicians have more, better, and earlier conversations. 3–6 Central to this approach is a clinician conversation guide for patient encounters. 2 While the SICP works for practicing clinicians, it has not been tested with medical trainees. The goal of this training is to enable future physicians to conduct effective serious illness discussions and provide goal-concordant care for patients. Approach: We adapted the SICP training to emphasize assessing prognostic awareness and responding to emotion. We developed a 2.5-hour SICP workshop for medical students and medical interns that included large- and small-group work, practice with an actor, and interdisciplinary clinician facilitators. We trained 81 students and 156 interns and obtained anonymous quantitative and qualitative feedback. Outcomes: Eighty-six percent of students and 91% of residents rated the session as “very good” or “excellent” and > 90% of all learners would either recommend this training or intended to apply this to their practice. Post-session learner confidence increased in all communication skills. Learners said the training provided a helpful framework and useful language for these conversations. Resident documentation of serious illness conversations in the medical record increased dramatically during the year following training commencement. Discussion: Grounded in principles of adult learning theory, this training was rated highly by trainees and resulted in demonstrable practice change, with significant increases in resident-documented serious illness conversations in the electronic health record. These early learners were more flexible and willing to try this approach than practicing clinicians who tend to resist or revert to old habits. Significance: A conversation guide represents a new paradigm for teaching communication skills and is valued by early learners. Our study is the largest report of SICP training for medical trainees and the only one to demonstrate behavioral change. The SICP training is a critical step to improving clinician confidence and perceptions of inadequate training in serious illness communication. Acknowledgments: The authors wish to thank the Massachusetts General Hospital Continuum Project for its support of this teaching effort.