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

Roberts, Benjamin; Mehta, Ankur; McWhirter, Michelle; Dy, Sydney M.; Wright, Scott M.; Wu, David

doi:10.1016/j.jpainsymman.2021.02.009

Cited by 8 publications

(6 citation statements)

References 14 publications

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“…Researchers have converted in-person trainings designed for organizational change agents to online trainings in clinical [ 8 ], community [ 7 , 9 ], and faith-based [ 10 ] settings, but these studies have not focused on the process and logistics of converting the trainings. Changing the delivery mode to online is not simply a matter of posting training slides with voice-over narration if the goal is to create an engaging training that increases user capacity and skills.…”

Section: Discussionmentioning

confidence: 99%

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A process for converting an in-person training to increase church capacity to implement physical activity and healthy eating practices and policies to an online format

Wilcox

Saunders

Stucker

et al. 2023

Translational Behavioral Medicine

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The implementation of evidence-based public health programs into practice is critical for improving health, but trainings for organizational change agents are often not scalable. To describe the process of converting a training that targets faith-based organizational capacity development from an in-person to an online format. We engaged in an iterative process to convert the training delivery mode from in-person to online that included assessing stakeholder support, consulting the literature on best practices, seeking a design team, consolidating content, designing engaging lessons, and building an online site. Feedback from end-users and other audiences was incorporated throughout. Pilot participants with characteristics like intended training users were then recruited via community and faith-based partner networks. They rated their agreement with statements about the effectiveness as well as design and functionality of each lesson and the overall training (1 = strongly disagree, 5 = strongly agree) and participated in a structured follow-up interview. Nine pilot participants (representing 9 churches in 7 states; 6 African American, 5 with health ministries) rated the online lessons favorably (all ratings ≥ 4.5). Most (90.4%) perceived the lesson duration to be “just right” and spent 52.5 ± 9.9 minutes/lesson. Participants evaluated the overall training positively (all ratings ≥ 4.7). Lesson content, resources, multimedia, and program ideas were most-liked aspects of lessons, while content, staff responsiveness, discussion board, and pace were most-liked aspects of the overall training in open-ended and interview responses. This paper shares a replicable process for converting training modalities from in-person to online with the goal of increased scalability.

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Section: Discussionmentioning

confidence: 99%

“…They reported implementation completeness and fidelity in the statewide dissemination study comparable to their original study which relied on in-person training. Roberts et al [ 8 ]. changed training for internal medicine interns from an in-person to an online format due to the COVID-19 pandemic.…”

Section: Introductionmentioning

confidence: 99%

A process for converting an in-person training to increase church capacity to implement physical activity and healthy eating practices and policies to an online format

Wilcox

Saunders

Stucker

et al. 2023

Translational Behavioral Medicine

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“…29,30 Reading-and writing-based sessions, often grounded in narrative medicine, have been used to inspire reflective practice, enhancement of bedside patient discussions, or engagement with patient experiences. [31][32][33] Though fewer respondents reported self-initiated visual arts engagement, there are also reports in the literature of the feasibility of visual arts-based GME curricula, including museum visits, engagement with community art, and multimedia longitudinal curricula applied toward learning objectives as diverse as improving observation skills, resilience, and bias awareness. [34][35][36][37][38] Further research is necessary to TA B L E 4 Common themes and representative quotations from adjunct analysis of written responses on role of humanities in medicine Themes/subthemes Representative quotations…”

Section: Discussionmentioning

confidence: 99%

“A sorely neglected field”: A multisite study of self‐reported humanities exposure among emergency medicine residents

Balhara

Irvin

Zink

et al. 2022

AEM Education and Training

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BackgroundThe Association of American Medical Colleges has identified the humanities as fundamental to medical education across all specialties. Evidence from undergraduate medical education (UME) demonstrates the humanities' positive impacts on outcomes that could be relevant to patient care and trainee well‐being in emergency medicine (EM) residency training. However, less is known about the humanities' role in graduate medical education (GME).ObjectivesThe objectives were to describe EM residents' self‐reported exposure to the humanities and its relationship with their empathy, tolerance of ambiguity, and patient‐centeredness, and to assess their attitudes toward the humanities in GME.MethodsThis cross‐sectional survey‐based study was conducted at six U.S. EM residency programs in 2018–2019. Quantitative analyses included linear regressions testing for trends between humanities exposures and outcomes, adjusted for sex, year in training, and clustering within programs; adjunct analysis of free‐text responses was performed using an exploratory constructivist approach to identify themes about views on the humanities' role in medicine.ResultsResponse rate was 54.8% (153/279). A total of 65% of respondents were male and 28.1% of respondents had a preceding humanities degree. Preceding humanities degree and current self‐reported humanities exposure were positively associated with performance on empathy subscales (p = 0.02). Seventy‐five percent (n = 114) of respondents agreed humanities are important in GME; free‐text responses revealed perceived positive impacts of humanities on generating well‐rounded clinicians and enhancing patient care.ConclusionsEngagement with the humanities may be associated with empathy among EM residents. Although the magnitude of associations was smaller than that seen in UME, this study demonstrates resident interest in humanities and suggests that extracurricular engagement with the humanities may be insufficient to prolong positive impacts seen in UME. Further research is needed to explore how to sustain these benefits through integration or addition of the humanities in existing GME curricula.

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“…The 3-Act Model, which has been previously described in detail, is a highly adaptive approach grounded on the patient’s story ( Figure 2 ) ( 6 – 8 ). We tailored the 3-Act Model teaching for PCCM fellows, and all eight clinical fellows completed it as part of their training (over a 2-week period from July–August 2020).…”

Section: Methodsmentioning

confidence: 99%

“…GOC conversations may be challenging and uncomfortable for providers, who often lack the confidence, knowledge, and skills to conduct them effectively ( 1 ). We have developed a novel narrative approach to GOC conversations, the 3-Act Model, and demonstrated effectiveness in teaching it to healthcare professionals as measured by objective skills proficiency assessment ( 6 – 8 ). Although important, education on its own is not enough to change practice in the ICU; thoughtfully designing and implementing systems changes, such as protocols and processes, are necessary ( 9 ).…”

mentioning

confidence: 99%

Integrating Narrative Goals of Care in the Medical Intensive Care Unit: Impact on Educational and Clinical Outcomes

Chatterjee¹,

Roberts

Ahluwalia³

et al. 2022

ATS Scholar

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Background High-quality goals of care (GOC) communication is fundamental to providing excellent critical care. Objective Educate medical intensive care unit (MICU) clinicians, design and implement workflows relating to GOC communication, and measure the impact on communication proficiency and rate of GOC documentation. Methods Guided by Lean Six Sigma principles, an interprofessional team from palliative and critical care tailored a multicomponent intervention—the 3-Act Model communication training and workflow modification—to equip and empower the pulmonary and critical care medicine (PCCM) fellow as the clinical lead for GOC discussions. Fellows’ education included in-person narrative reflection, asynchronous online didactic and demonstration videos of the 3-Act Model, online roleplays, and direct observation leading GOC discussions in the ICU. PCCM fellows were objectively evaluated for proficiency using the Goals of Care Assessment Tool. To evaluate the impact of our intervention on documented GOC conversations, we performed a retrospective chart review over two 3-month periods (before and after intervention) when the MICU cared exclusively for critically ill patients with coronavirus disease (COVID-19). Results All PCCM fellows demonstrated proficiency in GOC communication via online simulated roleplays, as well as in observed bedside GOC communication. Per chart review of patients with a minimum of 7 consecutive days in the MICU, documented GOC conversations were found for 5.55% (2/36) of patients during the preintervention period and for 28.89% (13/45) of patients in the postintervention period. Palliative care consults increased in the pre- versus postintervention period: for all patients, 4.85% versus 14.52% ( P < 0.05); for patients age ⩾80 years, 3.54% versus 29.41% ( P < 0.05); and for patients with MICU length of stay ⩾7 days, 2.78% versus 24.44% ( P < 0.05). Conclusion Combining 3-Act Model education for PCCM fellows with Lean Six Sigma quality improvement resulted in effective GOC communication training and improved palliative care integration in the ICU.

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

Cited by 8 publications

References 14 publications

A process for converting an in-person training to increase church capacity to implement physical activity and healthy eating practices and policies to an online format

A process for converting an in-person training to increase church capacity to implement physical activity and healthy eating practices and policies to an online format

“A sorely neglected field”: A multisite study of self‐reported humanities exposure among emergency medicine residents

Integrating Narrative Goals of Care in the Medical Intensive Care Unit: Impact on Educational and Clinical Outcomes

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