A Simulation-Based Mastery Learning Curriculum Ensures Competency in Discussing Goals of Care for ICU Clinicians

Outcomes 1. Upon successful completion, participants will be able to describe the model of simulation-based mastery learning (SBML) for medical education and how to apply to communication skills.2. Upon successful completion, participants will be able to describe outcomes from our curriculum and integrate and employ new methodology for teaching Late Goals of Care Conversations using a competency-based medical education approach. Key Message This study demonstrates that simulation-based mastery learning is an effective education model for achieving competency in leading late goals of care conversations. Since this model ensures uniform skill acquisition, it may be an effective training tool to more consistently achieve the positive outcomes associated with discussing goals of care. Introduction Goals of care conversations for patients in the late stages of illness are associated with multiple positive outcomes including improved goal-concordant care, improved bereavement outcomes for caregivers and decreased costs. Yet, there is a lack competency-based curricula for teaching late goals of care (GOC) conversations. Simulation-based mastery learning (SBML) is a form of competency-based medical education that has been shown to be highly effective for teaching communication skills. Objectives To demonstrate the feasibility of an SBML curriculum for late GOC conversations, and to train a cohort of critical care medicine (CCM) fellows and advanced practice providers (APPs) in this crucial conversation. Methods CCM fellows and APPs at an academic medical center participated in a one-day communication course. Participants completed a pretest encounter with a standardized patient, then received focused feedback using a 24-item standardized assessment tool with established inter-rater reliability. Next, they participated in an 8-hour workshop including a didactic, demo, and deliberate practice (DP) based on VitalTalk small group role play. After the workshop, each participant completed a posttest. Those who did not meet a minimum passing standard (MPS) received additional DP until they met the MPS on a repeat posttest. Results 18 participants were eligible for the study, and 13 (72%) completed all components. At baseline, no participants met the MPS. Checklist performance improved significantly from a median 46% (IQR 40%, 56.5%) at pretest to 96% (IQR 88%, 100%) after reaching mastery (p=0.001). All learners met the MPS after course completion and agreed/strongly agreed that they enjoyed the workshop and would recommend it to colleagues. Conclusions An SBML course for late GOC conversations for intensivists was feasible and all participants achieved mastery. SBML is an effective model for teaching this essential communication skill, and was well received by all participants. Keywords Communication / Shared Decision Making / Advance Care Planning