Enhancing Virtual Communication Skills Among Medical Learners: A COVID-19 Telemedicine Goals of Care Standardized Encounter (QI430)

OUTCOMES: 1. Evaluate the effectiveness of a virtual communication framework to conduct goals-of-care conversations 2. Emphasize the importance of adapting a complex communication curriculum to current telemedicine needs BACKGROUND: The COVID-19 pandemic has forced adaptations in medicine, causing rapid growth in the use of telemedicine to continue caring for patients. Although undergraduate medical education has also been forced to adapt curriculum to a distance learning or virtual model, many providers have no formal telemedicine or COVID-19-specific goals-of-care (GOC) training. Thus, a COVID-19 GOC telemedicine curriculum was developed to provide undergraduate medical learners (UMLs) the skills necessary to facilitate advance care planning (ACP) via a virtual platform. AIM STATEMENT: Develop an effective COVID-19 GOC telemedicine curriculum. METHODS: UMLs were given a 2-hour virtual training session using P-T-SPIKEES, a framework for conducting difficult discussions with patients via telemedicine. Training objectives included gaining an understanding of telemedicine, ACP, and risk factors for worsening COVID-19 disease to facilitate appropriate COVID-19 GOC conversations. UMLs underwent pre/post training surveys in addition to a GOC Telemedicine Objective Structured Clinical Examination (TeleOSCE). Learner pre/post training survey responses were compared to their GOC TeleOSCE performance evaluation to gauge effectiveness of this pilot program. RESULTS: N = 83 UMLs. UMLs who experienced systemic technical problems or had incomplete data lacking either a pre, post, or TeleOSCE evaluation survey were excluded from the study. 10% of UMLs had prior telemedicine training, 50% had prior GOC training, and 0% had previously participated in a TeleOSCE. After completing the curriculum, 68% received scores of excellent or above average on their TeleOSCE performance. UML self-evaluated GOC competency increased from 33% to 89%, a 2.7-fold increase, and TeleOSCE competency increased from 22% to 90%, a 4-fold increase. CONCLUSIONS AND IMPLICATIONS: A COVID-19 GOC telemedicine curriculum using the P-T-SPIKEES framework can effectively teach UMLs the skills necessary to facilitate COVID-19-focused GOC discussions via a virtual platform. Further studies should examine the use of the P-T-SPIKEES framework throughout different institutions and in graduate medical education.