Abstract
Context
The three-Act Model, a narrative approach to goals of care (GOC) discussions centered
on patients’ individual stories, has proven to be effective as measured by objective
skill improvement among medical trainees. This study describes the adaptation of the
in-person curriculum to a streamlined, online format, in the setting of the Covid19
pandemic. We hypothesized that high levels of skill proficiency and learner satisfaction
observed in previous in-person cohorts would be sustained amongst trainees in the
online setting.
Objective
Our primary aim was to assess the skills proficiency of a cohort of internal medicine
interns undergoing online training for GOC discussions with the three-Act Model. Our
secondary goal was to assess learners’ satisfaction with the prerecorded didactic
video and online role plays.
Methods
Our team used REDCap for the data collection, and as the user-facing hub for learners
to access didactic video content and for submitting surveys. We used Zoom to host
synchronous discussions and role-play sessions. Trainers used the previously validated
Goals of Care Assessment Tool (GCAT) to objectively rate intern proficiency in two
role plays each.
Results
Twenty-one internal medicine interns began the training; 20 completed the training
and were assessed using the GCAT. All but one intern who completed the training (19
of 20, 95%) achieved proficiency in leading a GOC discussion as measured objectively
using the GCAT. Learner satisfaction was high: 1) 100% of respondents recommended
the training to others as a “good” (26.7%) or “outstanding” experience (73.3%); 2)
93.3% were “satisfied” or “very satisfied” using a online, distance-learning format
for the prerecorded didactic component; 3) 80% were “satisfied” or “very satisfied”
using an online, distance-learning format for the role-play component; and 4) 93.3%
were content with the number of role plays. The amount of time dedicated to this training
decreased compared to prior years when done in person (six hours) – to four hours
and 40 minutes for learners and under four hours for trainers.
Conclusion
After completing the adapted online three-Act Model training, nearly all learners
were scored to be proficient in GOC communication skills and reported high satisfaction
with the online curriculum. Achieving high quality more efficiently represents genuine
educational value. Further, these online teaching results show that the three-Act
Model training can be delivered to geographically distanced learners.
Key Words
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Article info
Publication history
Published online: February 12, 2021
Accepted:
February 8,
2021
Identification
Copyright
© 2021 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
