Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
J Pain Symptom Manage. 2019 Dec;58(6):1033-1039.e1. doi: 10.1016/j.jpainsymman.2019.08.023. Epub 2019 Aug 28.
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.
To describe the development of the 3-Act Model curriculum and to assess its impact on the GOC communication skills of IM interns.
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).
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.
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.
需要创新的以患者为中心的方法来进行目标关怀（GOC）沟通培训。以患者独特的故事为中心的叙述方法在概念上是合理的，但尚未针对客观技能的获得进行评估。我们基于一种新颖的、易于记忆的 GOC 叙述方法（即三幕模型）开发了一门课程，并在内科住院医师（IM）实习生中进行了试点。
描述三幕模型课程的开发情况，并评估其对 IM 住院医师 GOC 沟通技能的影响。
该课程由多学科专家、IM 住院医师和患者/家属代表共同参与开发。课程的显著特点包括具有证据支持的工具开发、确定熟练标准以及创建角色扮演场景。在两个三小时的研讨会上，住院医师在教授前后（包括叙述反思、讲座和视频演示）分别以提供者和患者的身份参与角色扮演。
22 名住院医师在五个独特场景中扮演提供者的角色；可分析的熟练程度评分有 106 个。客观评分显示，住院医师的熟练程度从 30%（预测试）增加到 100%（最终角色扮演）。在培训结束时，96%的住院医师强烈或同意他们觉得自己能够独立领导基本的 GOC 讨论，并且随着角色扮演的进行，这一比例不断增加。所有住院医师都表示愿意推荐这种培训。
该试点表明，三幕模型是可教授的，并且受到学习者的赞赏。该 GOC 课程是第一个基于叙述方法的课程，证明了客观技能的提高。
