Narrative Approach to Goals of Care Discussions: A Novel Curriculum

Area of Science:

• Medical Education
• Communication Skills Training
• Patient-Centered Care

Background:

• Innovative patient-centered approaches to goals of care (GOC) communication training are needed.
• A narrative approach, focusing on the patient's story, is a promising but unevaluated method for GOC communication.
• The 3-Act Model was developed as a novel, memorable narrative framework for GOC communication.

Purpose of the Study:

• To describe the development of the 3-Act Model curriculum for GOC communication.
• To assess the impact of this curriculum on the objective communication skills of internal medicine (IM) interns.

Main Methods:

• A curriculum was developed with input from experts, residents, and patient representatives.
• The training involved two workshops with role-playing as both providers and patients, incorporating narrative reflection, didactics, and video demonstration.
• Objective skills were assessed using role-play scenarios and proficiency ratings.

Main Results:

• Interns' objective proficiency in GOC communication increased from 30% pre-training to 100% post-training.
• 96% of interns felt ready to lead GOC discussions independently after the training.
• All interns recommended the training, indicating high learner satisfaction.

Conclusions:

• The 3-Act Model curriculum is teachable and well-received by learners.
• This narrative-based GOC training is the first to demonstrate objective skills improvement.
• The 3-Act Model shows potential for enhancing GOC communication skills in medical trainees.