Incorporating Older Adults as “Trained Patients” to Teach Advance Care Planning to Third-Year Medical Students

Abstract

Background: Advance care planning (ACP) is a critical component of end-of-life (EoL) care, yet infrequently taught in medical training. Objective: We designed a novel curriculum that affords third-year medical students (MS3s) the opportunity to practice EoL care discussions with a trained older adult in the patient's home. Design: Volunteers were instructed as trained patients (TPs) to evaluate MS3s interviewing and communication skills. The MS3s received a didactic lecture and supplemental material about ACP. Pairs of MS3s conducted ACP interviews with TPs who gave verbal and written feedback to students. Student evaluations included reflective essays and pre/postsurveys in ACP skills. Settings and Participants: A total of 223 US MS3s participated in the curriculum. Results: Qualitative analysis of reflective essays revealed 4 themes: (1) students' personal feelings, attitudes, and observations about conducting ACP interviews; (2) observations about the process of relationship building; (3) learning about and respecting patients' values and choices; and (4) the importance of practicing the ACP skills in medical school. Students' confidence in skills significantly improved in all 7 domains (P < .001): (1) introduce subject of EoL; (2) define advance directives; (3) assess values, goals, and priorities; (4) discuss prior experience with death; (5) assess expectations about treatment and hospitalization; (6) explain cardiopulmonary resuscitation and outcomes; and (7) deal with own feelings about EoL and providers' limitations. Conclusions: The use of older adults as TPs in an ACP curriculum provides students an opportunity to practice skills and receive feedback in the nonmedical setting, thereby improving comfort and confidence in approaching these conversations for future patients.

A scoping review of the changing landscape of geriatric medicine in undergraduate medical education: curricula, topics and teaching methods

“…Simulation has been used to teach various topics, including delirium [ 45 ], elder abuse [ 46 ], frailty, falls and osteoporosis [ 47 ]. It has also been used to practice various skills, including communication with adults with dementia [ 48 , 49 ], interprofessional team working [ 50 ], medication management [ 51 – 53 ], end-of-life care discussions [ 54 ], CGA [ 55 ], basic oral and dental care in older adults [ 56 ], and management of depression in older adults [ 57 ].…”

Improving Medical and Nurse Practitioner Student Confidence and Clinical Skill in Advance Care Plan Development: A Multidisciplinary Mentorship Model

“…These include implementation of end of life (EOL)-focused didactic lectures, PC clerkships, EOL-based clinical electives, hospice volunteer experiences, standardized patient exercises,and PC clinical case seminars. [5][6][7][8][9][10] These initiatives have been impressive steps to improve ACP education, but consistent educational patterns and best-practice standards have yet to be established. 4,11 To address this educational gap, an interdisciplinary faculty team consisting of 2 ethicists, 2 PC specialists, a nurse practitioner faculty member and coordinator of the AGACNP intensivist focus, the institution's director for patient education, and a MD student piloted a 3-month learning opportunity for MD and AGACNP students at a large academic medical center.…”