Outpatient Advance Care Planning Internal Medicine Resident Curriculum: Valuing Our Patients’ Wishes

Chan, David W.; Ward, Elizabeth Cochran; Lapin, Brittany; Marschke, Michael; Thomas, Margaret; Lund, Amanda W.; Chandar, Manisha; Glunz, Catherine; Anderson, Valen; Ochoa, Peggy; Davidson, Joanna; Icayan, Liza; Wang, Ernest; Bellam, Shashi; Obel, Jennifer

doi:10.1089/jpm.2015.0313

Cited by 19 publications

(18 citation statements)

References 12 publications

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“…Participants suggested that provider training could help clarify when and how to initiate ACP conversations. ACP training increases providers’ knowledge, confidence and engagement with patients . Other recommended interventions such as integrating ACP delivery and documentation into healthcare protocols hold great promise because such interventions in the community have increased patient engagement in ACP .…”

Section: Discussionmentioning

confidence: 99%

“…[25][26][27] Other recommended interventions such as integrating ACP delivery and documentation into healthcare protocols hold great promise because such interventions in the community have increased patient engagement in ACP. 27,28 Participants recommended addressing lack of psychosocial support by integrating family into ACP discussions when possible and providing a patient advocate or peer support. A previous study noted that effective ACP was contingent on psychosocial support 22 but further research is needed to understand inmates' unique psychosocial needs during ACP.…”

Section: Discussionmentioning

confidence: 99%

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"We Take Care of Patients, but We Don't Advocate for Them": Advance Care Planning in Prison or Jail

Ekaireb

Ahalt

Sudore

et al. 2018

J American Geriatrics Society

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Background: Despite rapidly aging populations in prisons and jails, evidence suggests that advance care planning (ACP), an essential component of geriatric care, is not widely conducted in correctional healthcare settings. Objectives: Investigate correctional health care providers’ ACP knowledge and experience, their perspectives on barriers to ACP in correctional settings and how to overcome those barriers. Design: Qualitative Study Setting: Four prisons across two states and one large city jail in a third state. Participants: 24 correctional healthcare providers (e.g. physicians, nurses, social workers) participated in individual semi-structured phone interviews about ACP in correctional settings. Results: Participants demonstrated low baseline ACP knowledge; 85% reported familiarity with ACP, but only 42% provided accurate definitions of ACP. Fundamental misconceptions included the belief that ACP was done by providers without soliciting patient input. Multiple ACP barriers were identified, many of which are unique to prison and jail facilities, including provider uncertainty about the legal validity of ACP documents in prison/jail, patient mistrust of the correctional healthcare system, patients’ isolation from family/friends, and institutional policies that restrict use of ACP. Clinicians’ suggestions for overcoming those barriers included ACP training for clinicians, creating psychosocial support opportunities for patients, revising policies that limit ACP, and systematically integrating ACP into healthcare practice. Conclusion: Despite an increasing number of older and seriously ill patients in prisons and jails, many correctional healthcare providers lack knowledge about ACP. In addition to ACP barriers found in the community, unique barriers to ACP exist in prisons/jails. Future research and policy innovation are needed to develop clinical training programs and identify ACP implementation strategies for use in correctional settings.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

"We Take Care of Patients, but We Don't Advocate for Them": Advance Care Planning in Prison or Jail

Ekaireb

Ahalt

Sudore

et al. 2018

J American Geriatrics Society

View full text Add to dashboard Cite

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“…Two studies showed improvements in knowledge and self-assessed skills after didactic content, and they both combined traditional didactics with online simulation or role playing. 13,14 Multiple studies explored the benefits of mandated rotations in concert with didactic content, [15][16][17] and all found high learner satisfaction and improved knowledge on posttesting, but no changes in attitudes or behaviors. Numerous curricular interventions focusing on chronic pain and substance abuse were published in the last several years.…”

Section: Curriculum Developmentmentioning

confidence: 99%

A Decade of Teaching and Learning in Internal Medicine Ambulatory Education: A Scoping Review

Coyle

Helenius

Cruz

et al. 2019

Journal of Graduate Medical Education

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Background Ambulatory training in internal medicine residency programs has historically been considered less robust than inpatient-focused training, which prompted a 2009 revision of the Accreditation Council for Graduate Medical Education (ACGME) Program Requirements in Internal Medicine. This revision was intended to create a balance between inpatient and outpatient training standards and to spur innovation in the ambulatory setting. Objective We explored innovations in ambulatory education in internal medicine residency programs since the 2009 revision of the ACGME Program Requirements in Internal Medicine. Methods The authors conducted a scoping review of the literature from 2008 to 2017, searching PubMed, ERIC, and Scopus databases. Articles related to improving educational quality of ambulatory components of US-based internal medicine residency programs were eligible for inclusion. Articles were screened for relevance and theme categorization and then divided into 6 themes: clinic redesign, curriculum development, evaluating resident practice/performance, teaching methods, program evaluation, and faculty development. Once a theme was assigned, data extraction and quality assessment using the Medical Education Research Study Quality Instrument (MERSQI) score were completed. Results A total of 967 potentially relevant articles were discovered; of those, 182 were deemed relevant and underwent full review. Most articles fell into curriculum development and clinic redesign themes. The majority of included studies were from a single institution, used nonstandardized tools, and assessed outcomes at the satisfaction or knowledge/attitude/skills levels. Few studies showed behavioral changes or patient-level outcomes. Conclusions While a rich diversity of educational innovations have occurred since the 2009 revision of the ACGME Program Requirements in Internal Medicine, there is a significant need for multi-institution studies and higher-level assessment.

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“…40 Trainee knowledge, including knowledge of communication strategies, improved. Similar simulationbased ethics and communications curricula have been piloted for neurosurgical residents, 41 internal medicine residents, 42 geriatrics medicine fellows, 43 ethics committee members, 44 nursing students, 45 and nurse-midwifery students. 46 Another innovative pedagogical technique that merges active and passive modalities is the inverted or flipped classroom.…”

Section: New Modalities In Medical Ethics Educationmentioning

confidence: 99%

Medical Ethics Education for Neurology Residents: Where Do We Go from Here?

Traner

Tolchin

2018

Semin Neurol

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Neurologists regularly confront complex clinical scenarios that require the application of ethical principles to achieve a respectful and fair resolution. In this article, we describe the types of ethically precarious scenarios neurologists encounter, the current status of standards for ethics and communication training for neurology residents, and the present practice of ethics training in neurology residency programs. We make recommendations for optimizing bioethics training for neurology residents and suggest methods for assessing the efficacy of these training initiatives. We emphasize the current need for strengthening the practical bioethics skills of neurologists.

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Outpatient Advance Care Planning Internal Medicine Resident Curriculum: Valuing Our Patients’ Wishes

Cited by 19 publications

References 12 publications

"We Take Care of Patients, but We Don't Advocate for Them": Advance Care Planning in Prison or Jail

"We Take Care of Patients, but We Don't Advocate for Them": Advance Care Planning in Prison or Jail

A Decade of Teaching and Learning in Internal Medicine Ambulatory Education: A Scoping Review

Medical Ethics Education for Neurology Residents: Where Do We Go from Here?

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