An exploration of contextual dimensions impacting goals of care conversations in postgraduate medical education

Ordons, Amanda L Roze des; Lockyer, Jocelyn; Hartwick, Michael; Sarti, Aimee; Ajjawi, Rola

doi:10.1186/s12904-016-0107-6

Cited by 23 publications

(28 citation statements)

References 36 publications

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“…Together, these hidden curricula subverted formal curricula and contributed to burnout. Building on prior studies, which suggest that GoC discussions are sources of conflict and distress, 14,17,64 as well as those demonstrating a decline in idealism during training, 44,65,66 this study goes further to show a negative impact on identity.…”

Section: Discussionmentioning

confidence: 78%

Medical students’ experiences with goals of care discussions and their impact on professional identity formation

2019

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Context Goals of care (GoC) discussions occur amongst patients, family members and clinicians in order to establish plans of care and are invaluable aspects of end‐of‐life care. In previous research, medical learners have reported insufficient training and emotional distress about end‐of‐life decision making, but most studies have focused on postgraduate trainees and have been quantitative or have evaluated specific educational interventions. None have qualitatively explored medical students’ experiences with GoC discussions, their perceptions of associated hidden curricula, and the impacts of these on professional identity formation (PIF), the individualised developmental processes by which laypersons evolve to think, act and feel like, and ultimately become, medical professionals. Methods Using purposive sampling at one Canadian medical school, individual semi‐structured interviews were conducted with 18 medical students to explore their experiences with GoC discussions during their core internal medicine clerkship. Interviews were audiorecorded, transcribed and anonymised. Concurrently with data collection, transcripts were analysed iteratively and inductively using interpretative phenomenological analysis, a qualitative research approach that allows the rich exploration of subjective experiences. Results Participants reported minimal support and supervision in conducting GoC discussions, which were experienced as ethically challenging, emotionally powerful encounters exemplifying tensions between formal and hidden curricula. Role modelling and institutional culture were key mechanisms through which hidden curricula were transmitted, subverting formal curricula in doing so and contributing to participants’ emotional distress. Participants’ coping responses were generally negative and included symptoms of burnout, the pursuit of standardisation, rationalisation, compartmentalisation and the adaptation of previously held, more idealised professional identities. Conclusions GoC discussions in this study were often led by inexperienced medical students and impacted negatively on their PIF. Through complex emotional processes, they struggled to reconcile earlier concepts of physician identities with newly developing ones and often reluctantly adopted suboptimal professional behaviours and attitudes. Improved education about GoC discussions is necessary for patient care and may represent concrete and specific opportunities to influence students’ PIF positively.

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Section: Discussionmentioning

confidence: 78%

Medical students’ experiences with goals of care discussions and their impact on professional identity formation

2019

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“…Internationally, there is a lack of literature on the education of competencies in EoLC in both postgraduate trainees and especially in GP trainees: There are few published curricula such as from 2016 [37] and the questions of how and how much of teaching of EoLC is necessary during specialisation in general practice. If for example communicational skills in EoLC should be trained or if an intense course on EoLC is developed a well-planned curriculum based on previous experiences is mandatory [38,39]. A recent study, which was not available in 2016 when we had planned our study, presented a list of necessary learning objectives and goals for EoLC [40].…”

Section: Discussionmentioning

confidence: 99%

How to ensure basic competencies in end of life care – a mixed methods study with post-graduate trainees in primary care in Germany

et al. 2020

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Background: Providing end of life care (EoLC) is an important aspect of primary care, which reduces the risk of hospital admission for most patients. However, general practitioners (GPs) seem to have low confidence in their ability to provide EoLC. Little is known about an adequate volume and kind of training in EoLC among GP trainees. Methods: We performed a before-after comparison in all postgraduate GP trainees who were registered in the vocational training program (KWBW VerbundweiterbildungPLUS). They were offered participation within a two-day seminar focussing on palliative care in 2017. Those who attended the seminar (intervention group I) completed a paper-based questionnaire directly before the intervention (T 1) and 6 months after (T 2). None-attendees (group C) were also asked to fill out the questionnaire once. The questionnaire covered previous experiences in palliative care, self-assessment of competencies in EoLC in the organisation of patient care as well as in control of symptoms, attitudes towards death and caring for dying patients and questions about GPs' role in EoLC. Results: In total, 294 GP trainees (I: n = 219; C: n = 75) participated in the study. Of those, more than 90% had previously gained experience in EoLC mainly during vocational training in the hospital rotation. Around a third had previously gained competencies in EoLC in medical school. Between groups I (T 1) and C no significant differences were observed in socio-demographic characteristics, pre-existing experience or overall expertise. At T 2, 75% of participants of group I declared they have extended their competencies in EoLC after the intervention and 70% classified the intervention as helpful or very helpful. Overall, they rated their competencies significantly higher than at T 1 (p < 0.01). In detail, competencies in organisation of EoLC and competencies in handling of symptoms significantly improved (p < 0.01). Due to the intervention, 66% could reflect their attitudes towards dying, death and grief and 18% changed their attitudes. Group I highlighted palliative care as one of GPs tasks (Likert 4.47/5, SD 0.75). Conclusions: The intervention fostered personal competencies, understanding and self-confidence in EoLC among GP trainees. This is crucial for the aim to broadly provide EoLC.

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“…Masters K, Treasure-Jones T, Elferink R MedEdPublish https://doi.org/10.15694/mep.2018.0000072.1 Communication skills are essential for health professionals, and are used in day-to-day interaction with patients and colleagues. (Epner and Baile 2014;Hinkle et al 2017;Modi et al 2016;Roze des Ordons et al 2016;Sanson-Fisher and Cockburn 1997) Current medical student communication skills' training and assessment focuses on face-toface, verbal communication. (Boileau, Patenaude, and St-Onge 2018;Goldhamer et al 2018;Hinkle et al 2017;Joyce, Steenbergh, and Scher 2010) As we progress through the 21 st century, however, more and more communication happens electronically and asynchronously; while health professionals' communication via email and texting has been explored, other forms of communication will need attention as their potential becomes more obvious.…”

Section: Electronic Communication Skillsmentioning

confidence: 99%

Teaching Medical and Health Sciences students to develop e-posters with Learning Toolbox

Masters¹,

Treasure-Jones²,

Elferink³

2018

MedEdPublish

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Introduction: In the 21 st Century, medical personnel require electronic and written communication skills in order to communicate with colleagues and patients. These specific skills are seldom taught, as communication skills' teaching and assessment currently emphasises face-to-face, verbal communications. This study aims at teaching some skills required for electronic communication, and evaluating the process. Methodology: We used a specific platform to teach 188 medical and health sciences students, working in groups, to develop e-posters that run as mobile apps, and evaluated the process in terms of resource demands, students' experience (through an online survey), and e-poster quality. Results: From 188 students, a total of 144 students submitted 30 accessible e-posters, and 71 students participated in the survey. The resource demand was equivalent to resource demand for teaching paper poster design and creation. Despite technical problems not related to the platform, the students were able to produce acceptable quality eposters with reasonable effort. Discussion and Conclusion: This study indicates that it is possible to teach medical and health sciences students the basics of e-poster design, and extend their communication abilities into the realm of electronic communication. This bodes well to prepare them to take their place as e-poster creators in a broad range of spheres, especially for academic conferences and patient communication.

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An exploration of contextual dimensions impacting goals of care conversations in postgraduate medical education

Cited by 23 publications

References 36 publications

Medical students’ experiences with goals of care discussions and their impact on professional identity formation

Medical students’ experiences with goals of care discussions and their impact on professional identity formation

How to ensure basic competencies in end of life care – a mixed methods study with post-graduate trainees in primary care in Germany

Teaching Medical and Health Sciences students to develop e-posters with Learning Toolbox

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