Enhancing Competency in Professionalism: Targeting Resident Advance Directive Education

Abstract

Our study highlighted the continuing need for advance directive resident curricula. Medical school curricula alone do not appear to be sufficient for residents' needs in this area.

Evaluating Residents' Readiness to Elicit Advance Care Plans

“…10,11 Since performance improved with experience and seniority, our results suggest that experience and supervision are likely to be useful in increasing resident self-confidence and competence with this task. Other data suggest that improved competence in this domain is best achieved through modeling and facilitated practice.…”

“…Despite increased trainee education on communication strategies and advance care planning discussions, residents are typically stressed by this role and are inadequately prepared. [1][2][3][4] While learning the skills necessary to effectively engage in advance care planning for patients facing a serious illness is challenging, training and clinical experience are both associated with increases in selfperceived competence in providing end-of-life care. 5,6 We were unable to identify an existing tool to evaluate residents' readiness to engage in discussions about advance care planning.…”

Improving Advance Care Planning in a Resident Primary Care Clinic

“…While there are multiple studies on interventions to increase advance directives, [10][11][12][13][14][15][16][17][18][19] fewer have implemented interventions in a resident primary care clinic. [20][21][22][23] The primary aim of this study was to develop an intervention to increase the number of uploaded advance directives in the electronic medical record for patients who receive primary care at an internal medicine residency primary care clinic. Our secondary aims were to increase resident confidence with discussing ACP and to increase the number of patients aged 65 years and older who are counseled during a clinic appointment.…”

“…24 The questionnaire was informed by previous studies and asked residents to describe, on a Likert scale, their confidence with ACP documents and discussions, barriers to completing an advance directive, and knowledge of ACP in the electronic medical record. 20,22 The postintervention questionnaire was sent to the same residents 2 months after the intervention and the pre-and postintervention responses were compared within participants. Informed consent was obtained via the electronic signature in REDCap from residents participating in the study and waived for the chart review of patients.…”

“…Furthermore, the pre-post study design is at risk of unmeasured confounding variables. The resident survey questionnaires, although informed by previous studies, 20,22 are not validated. Our study may underestimate the number of advance directives uploaded as a result of our study intervention because the chart review typically only captured one follow-up visit for patients during the 3-month postintervention study period.…”