Discussing life-sustaining treatment. A teaching program for residents

Area of Science:

• Medical Education
• Bioethics
• Patient Communication

Background:

• Discussions regarding patient preferences for life-sustaining treatment are often not initiated before cognitive impairment or critical illness.
• Effective communication skills are essential for physicians to address advance care planning.
• There is a need for structured training programs to equip healthcare professionals with the necessary competencies.

Purpose of the Study:

• To evaluate an educational program designed to enhance residents' skills in discussing advance directives with patients.
• To assess the impact of simulated patient encounters on resident learning and confidence in advance care planning conversations.

Main Methods:

• A training program was developed where residents practiced discussing advance directives with simulated outpatients.
• Residents received feedback from the simulated patient, an observing resident, and a faculty member.
• Resident self-ratings were collected to measure changes in knowledge, skills, and attitudes.

Main Results:

• Residents reported the training sessions as realistic, relevant, and useful.
• Significant improvements were observed in resident self-ratings across eight items related to advance directive discussions.
• Key learning areas included technical knowledge, topic introduction, patient information dissemination, and eliciting patient values.

Conclusions:

• Residents demonstrate a clear need and desire for training in discussing advance directives.
• Simulated patient encounters serve as an effective educational tool to facilitate learning in advance care planning.
• This training approach can enhance physicians' ability to conduct sensitive end-of-life discussions.