title: Outpatient Advance Care Planning Internal Medicine Resident Curriculum: Valuing Our Patients' Wishes.
abstract: Although many studies have illustrated the discomfort that resident physicians feel when discussing end-of-life (EOL) issues with their patients, fewer studies have addressed interventions to directly increase medical resident proficiency and comfort in conducting these discussions and for translating these beliefs into a formal advance care plan.
  
  
  
  We report on an innovative curriculum conducted at The University of Chicago (NorthShore) internal medicine residency to improve residents' proficiency and comfort in leading outpatient advance care planning (ACP) discussions.
  
  
  
  Four educational components were executed. First, residents completed an on-line module introducing ACP and guiding residents to complete their own ACP. Second, residents attended a didactic "How To" lecture given by physicians with expertise in ACP that emphasized ACP communication tools and a video demonstration. Third, residents completed a video-recorded simulation-based ACP discussion with a standardized patient. Finally, residents conducted an ACP outpatient encounter with one of their continuity clinic patients. Expert preceptors directly observed, evaluated, and provided feedback to residents during both patient encounters. Residents were surveyed before and immediately after the curriculum using a nine-variable questionnaire, which assessed the resident's training and comfort with ACP.
  
  
  
  Sixteen second year residents completed the curriculum and surveys. Precurriculum and post-curriculum mean change on a Likert scale of 1 (uncomfortable) to 5 (very comfortable) was compared using paired t-tests. Results demonstrated statistically significant improvements in the following comfort level variables: eliciting understanding of health and prognosis (pre 3.63 vs. post 4.38, p = 0.035), discussing EOL care based on patient values (pre 3.50 vs. post 4.38, p = 0.008), specifically discussing EOL care based on patient values in the outpatient setting (pre 2.75 vs. post 4.31, p = 0.001) and initiating an advance directive and medical power of attorney (pre 2.56 vs. post 4.19, p < 0.001).
  
  
  
  A multimodality curriculum including self-directed learning, lectures, and practice with simulated and actual outpatients with active reflection and feedback is effective in improving resident comfort level and formal training in ACP. Further research is needed to understand whether these interventions will translate into an increased frequency of discussions with patients about ACP after residency training.
authors.affiliation: 1 NorthShore Evanston Hospital, University of Chicago , Chicago, Illinois.
authors.forename: David
authors.initials: D
authors.lastname: Chan
authors.affiliation: 1 NorthShore Evanston Hospital, University of Chicago , Chicago, Illinois.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Ward
authors.affiliation: 2 NorthShore University HealthSystem , Evanston, Illinois.
authors.forename: Brittany
authors.initials: B
authors.lastname: Lapin
authors.affiliation: 2 NorthShore University HealthSystem , Evanston, Illinois.
authors.forename: Michael
authors.initials: M
authors.lastname: Marschke
authors.affiliation: 2 NorthShore University HealthSystem , Evanston, Illinois.
authors.forename: Margaret
authors.initials: M
authors.lastname: Thomas
authors.affiliation: 2 NorthShore University HealthSystem , Evanston, Illinois.
authors.forename: Amanda
authors.initials: A
authors.lastname: Lund
authors.affiliation: 1 NorthShore Evanston Hospital, University of Chicago , Chicago, Illinois.
authors.forename: Manisha
authors.initials: M
authors.lastname: Chandar
authors.affiliation: 2 NorthShore University HealthSystem , Evanston, Illinois.
authors.forename: Catherine
authors.initials: C
authors.lastname: Glunz
authors.affiliation: 2 NorthShore University HealthSystem , Evanston, Illinois.
authors.forename: Valen
authors.initials: V
authors.lastname: Anderson
authors.affiliation: 2 NorthShore University HealthSystem , Evanston, Illinois.
authors.forename: Peggy
authors.initials: P
authors.lastname: Ochoa
authors.affiliation: 2 NorthShore University HealthSystem , Evanston, Illinois.
authors.forename: Joanna
authors.initials: J
authors.lastname: Davidson
authors.affiliation: 2 NorthShore University HealthSystem , Evanston, Illinois.
authors.forename: Liza
authors.initials: L
authors.lastname: Icayan
authors.affiliation: 2 NorthShore University HealthSystem , Evanston, Illinois.
authors.forename: Ernest
authors.initials: E
authors.lastname: Wang
authors.affiliation: 2 NorthShore University HealthSystem , Evanston, Illinois.
authors.forename: Shashi
authors.initials: S
authors.lastname: Bellam
authors.affiliation: 2 NorthShore University HealthSystem , Evanston, Illinois.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Obel
mesh_terms: D032722:Advance Care Planning; D003479:Curriculum; D006801:Humans; D007388:Internal Medicine; D007396:Internship and Residency; D010045:Outpatients