Feasibility and Effectiveness of a Mnemonic Approach to Teach Residents How to Assess Goals of Care

Abstract

Background: Shared decision making is a collaborative process that allows patients, or their surrogates, and clinicians to make health care decisions together. There is an imperative to teach young physicians early in their training the importance of engaging in a shared decision-making process to define overall goals of care (GOC). The PERSON mnemonic proposes a structured format that allows providers to evaluate GOC across the spectrum of serious illnesses, outside of breaking bad news or end-of-life planning. Objectives: This study evaluated the utility of the PERSON mnemonic in training residents to have GOC with their patients, and investigated if these skills translated to the bedside with real patient encounters. Methods: First-year residents were divided into groups to participate in an in-depth education session. A pre-/ postbaseline survey was administered immediately after the education intervention and approximately seven months later to assess retention and utility. Results: Thirty first-year residents were eligible for this study; 30 attended the educational sessions and completed the immediate baseline pre-/postsurvey and the seven-month follow-up survey, resulting in 100% retention rate throughout study. Residents found sustained utility in the mnemonic. It was significantly successful in increasing the knowledge and confidence level in exploring GOC. Patient-centered outcomes could not be analyzed due to low response rates and limited granularity of hospital-level data. Conclusion: The PERSON mnemonic is a feasible and useful format for teaching residents how to have a GOC discussion.

ABCs of Heart Failure Management: A Guide for Nurse Practitioners

“…This study concluded that although not all letters of the mnemonic were remembered 7 months later, most of the participants were still able to apply it. 6 A 2018 study likewise demonstrated a decrease in peripheral intravenous infiltration with the application of a 5-letter mnemonic by pediatric registered nurses. 7 Here we provide clinicians with an alphabetical mnemonic to guide their pharmacotherapeutic decisions when treating patients with HFrEF.…”

“…Success was evaluated by a presurvey and postsurvey completed 7 months after the session. 6 Results demonstrated that 29 of 30 participants reported the mnemonic made sense immediately after the session, and 28 of 30 felt it made sense 7 months later. Approximately 93% reported that the mnemonic was beneficial and useful immediately after the session, and 86.67% reported it was useful 7 months later.…”

“…2e4 Mnemonics are memory tools that aid clinicians to easily recall and encode new information, thus freeing up cognitive space. 5 In a study published in 2019, 6 30 internal medicine residents participated in using a mnemonic with the objective of creating a structured approach for initiation of goals of care conversations. The 30 students were split into groups of 4 or 5 and underwent a 90-minute session to review the mnemonic and apply it in a simulation.…”

“…The 30 students were split into groups of 4 or 5 and underwent a 90-minute session to review the mnemonic and apply it in a simulation. 6 The groups addressed the scenario by having 1 resident engage in the conversation at a time, eventually working through the entire mnemonic. Success was evaluated by a presurvey and postsurvey completed 7 months after the session.…”

MVP–Medical Situation, Values, and Plan: A Memorable and Useful Model for All Serious Illness Conversations

“… 1 , 2 , 3 , 4 , 5 To redress this predicament, medical communication experts have published a variety of communication models designed to aid and promote SIC facilitation. 6 , 7 , 8 , 9 , 10 We three clinician-educators are among their many beneficiaries. Yet despite their value, our experience in communication education and clinical encounters has revealed three recurring impediments to their instruction, retention, and usefulness.…”