Narrative Approach to Goals of Care Discussions: Adapting the 3-Act Model Training to an Online Format.

Abstract Context The 3-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 3-Act Model. Our secondary goal was to assess learners’ satisfaction with the pre-recorded 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 2 role plays each. Results Twenty-one internal medicine interns began the training; 20 completed the training and were assessed using the GCAT. All but 1 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: (i) 100% of respondents recommended the training to others as a ‘good’ (26.7%) or ‘outstanding’ experience (73.3%); (ii) 93.3% were ‘satisfied’ or ‘very satisfied’ using a online, distance-learning format for the pre-recorded didactic component; (iii) 80% were ‘satisfied’ or ‘very satisfied’ using an online, distance-learning format for the role-play component; and (iv) 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 (6 hours) – to 4 hours and 40 minutes for learners and under 4 hours for trainers. Conclusion After completing the adapted online 3-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 3-Act Model training can be delivered to geographically distanced learners.