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J Pain Symptom Manage. 2019 Dec;58(6):1033-1039.e1. doi: 10.1016/j.jpainsymman.2019.08.023. Epub 2019 Aug 28.

Narrative Approach to Goals of Care Discussions: A Novel Curriculum.

Author information

1
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. Electronic address: dwu38@jhmi.edu.
2
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
3
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Health Policy and Management, Bloomberg School of Public Health, Baltimore, Maryland, USA.

Abstract

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.

KEYWORDS:

Communication skills curriculum; assessment tool; graduate medical education; narrative medicine; primary palliative care; role-play learning

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