Palliative Care Program, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Palliative Care Program, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
J Pain Symptom Manage. 2021 Jul;62(1):197-201. doi: 10.1016/j.jpainsymman.2021.02.009. Epub 2021 Feb 13.
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.
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.
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.
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.
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.
三幕式模型是一种以患者个体故事为中心的目标关怀（GOC）讨论叙事方法，已被证明在医学实习生的客观技能提高方面是有效的。本研究描述了在 COVID-19 大流行期间，将面对面课程改编为精简的在线格式。我们假设，在之前的面对面培训中观察到的高水平技能熟练程度和学习者满意度将在在线培训中得以维持。
我们的主要目的是评估接受三幕式模型在线 GOC 讨论培训的内科实习医生的技能熟练程度。我们的次要目标是评估学习者对预录的教学视频和在线角色扮演的满意度。
我们的团队使用 REDCap 进行数据收集，并将其作为学习者访问教学视频内容和提交调查的用户界面。我们使用 Zoom 主持同步讨论和角色扮演会议。培训师使用先前验证的目标关怀评估工具（GCAT）对每个实习生的两次角色扮演进行客观评分。
21 名内科实习医生开始了培训；20 名完成培训并使用 GOCAT 进行评估。除了一名完成培训的实习生（20 名中的 19 名，95%）外，所有实习生在使用 GOCAT 客观评估时都达到了主导 GOC 讨论的熟练程度。学习者满意度很高：1）100%的受访者将培训推荐给他人，认为这是一种“好”（26.7%）或“优秀”（73.3%）的体验；2）93.3%的人对预录教学部分的在线远程学习格式感到“满意”或“非常满意”；3）80%的人对角色扮演部分的在线远程学习格式感到“满意”或“非常满意”；4）93.3%的人对角色扮演的数量感到满意。与过去面对面培训相比，培训时间缩短了（六小时）——学习者为四小时四十分钟，培训师为四小时以下。
完成改编后的在线三幕式模型培训后，几乎所有学习者都被评为在 GOC 沟通技能方面熟练，并对在线课程表示高度满意。以更高的效率实现高质量代表了真正的教育价值。此外，这些在线教学成果表明，三幕式模型培训可以提供给地理位置分散的学习者。
