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Training Residents in Virtual Advance Care Planning: A New Twist in Telehealth.
Mills, Sarah; Cioletti, Anne; Gingell, Gareth; Ramani, Subha.
  • Mills S; Dell Medical School, Department of Internal Medicine, Austin, Texas, USA. Electronic address: sarah.mills@austin.utexas.edu.
  • Cioletti A; Dell Medical School, Department of Internal Medicine, Austin, Texas, USA; Dell Medical School, Department of Population Health, Austin, Texas, USA.
  • Gingell G; The University of Texas at Austin, STEM Education Doctoral Program, Department of Curriculum and Instruction, Austin, Texas, USA.
  • Ramani S; Harvard Medical School and Brigham and Women's Hospital, Department of Medicine, Boston, Massachusetts, USA.
J Pain Symptom Manage ; 62(4): 691-698, 2021 10.
Article in English | MEDLINE | ID: covidwho-1164114
ABSTRACT
CONTEXT Advance care planning (ACP) conversations represent an important physician skill, a need further highlighted by the COVID-19 pandemic. Most resident ACP training occurs in inpatient, settings, often featuring goals of care (GOC) conversations during a crisis. Outpatient clinics are valuable but underutilized settings to provide skills training for residents, yet little research has been done in these spaces.

OBJECTIVE:

We sought to 1) create an ACP curriculum harnessing the principles of a community of practice in a virtual format, and 2) obtain residents' perspectives regarding their skills and confidence in having early GOC conversations in the outpatient setting.

METHODS:

We interviewed 48 internal medicine residents using questionnaires, reflective narratives, and transcripts of debriefing conversations. We created a virtual curriculum during the ambulatory week which included didactics, virtual role plays, ACP phone conversations with five patients, and group debriefings. Quantitative data were analyzed for changes in resident confidence. Qualitative data were coded using thematic analysis, guided by instructor field notes.

RESULTS:

Residents reported decreased confidence in navigating advance directive conversations following training [Z=2.24, P=0.03, r = 0.33]. Resident reflections indicated that they felt more practiced at inpatient late GOC conversation skills, and that these skills were not fully transferable to the outpatient early GOC setting. Residents also endorsed the ambulatory environment as the best space for ACP conversations.

CONCLUSION:

This study illustrates the feasibility of a virtual format for ACP curriculum. The virtual community of practice created space for a metacognitive unmasking of prior resident unconscious incompetence. Also, inpatient, crisis-oriented late GOC conversation skills may translate poorly to the outpatient setting requiring early and ongoing GOC skills. Residents need more training to navigate ACP conversations in ambulatory environments.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Telemedicine / Advance Care Planning / COVID-19 / Internship and Residency Type of study: Observational study / Qualitative research Limits: Humans Language: English Journal: J Pain Symptom Manage Journal subject: Neurology / Psychophysiology / Therapeutics Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Telemedicine / Advance Care Planning / COVID-19 / Internship and Residency Type of study: Observational study / Qualitative research Limits: Humans Language: English Journal: J Pain Symptom Manage Journal subject: Neurology / Psychophysiology / Therapeutics Year: 2021 Document Type: Article