“Get the DNR”: residents’ perceptions of goals of care conversations before and after an e-learning module

Background: Residents frequently lead goals of care (GoC) conversations with patients and families to explore patient values and preferences and to establish patient-centered care plans. However, previous work has shown that the hidden curriculum may promote physician-driven agendas and poor commun...

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Autores principales:	Leora Branfield Day, Stephanie Saunders, Leah Steinberg, Shiphra Ginsburg, Christine Soong
Formato:	article
Lenguaje:	EN
Publicado:	Canadian Medical Education Journal 2021
Materias:	Education (General) L7-991 Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/d4473d4673484e03af93bbc990d1f9f4
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spelling	oai:doaj.org-article:d4473d4673484e03af93bbc990d1f9f42021-12-01T22:35:26Z“Get the DNR”: residents’ perceptions of goals of care conversations before and after an e-learning module 10.36834/cmej.719561923-1202https://doaj.org/article/d4473d4673484e03af93bbc990d1f9f42021-10-01T00:00:00Zhttps://journalhosting.ucalgary.ca/index.php/cmej/article/view/71956https://doaj.org/toc/1923-1202 Background: Residents frequently lead goals of care (GoC) conversations with patients and families to explore patient values and preferences and to establish patient-centered care plans. However, previous work has shown that the hidden curriculum may promote physician-driven agendas and poor communication in these discussions. We previously developed an online learning (e-learning) module that teaches a patient-centered approach to GoC conversations. We sought to explore residents’ experiences and how the module might counteract the impact of the hidden curriculum on residents’ perceptions and approaches to GoC conversations. Methods: Eleven first-year internal medicine residents from the University of Toronto underwent semi-structured interviews before and after completing the module. Themes were identified using principles of constructivist grounded theory. Results: Prior to module completion, residents described institutional and hierarchical pressures to “get the DNR” (Do-Not-Resuscitate), leading to physician-centered GoC conversations focused on code status, documentation, and efficiency. Tensions between formal and hidden curricula led to emotional dissonance and distress. However, after module completion, residents described new patient-centered conceptualizations and approaches to GoC conversations, feeling empowered to challenge physician-driven agendas. This shift was driven by greater alignment of the new approach with their internalized ethical values, greater tolerance of uncertainty and complexity in GoC decisions, and improved clinical encounters in practice. Conclusion: An e-learning module focused on teaching an evidence-based, patient-centered approach to GoC conversations appeared to promote a shift in residents’ perspectives and approaches that may indirectly mitigate the influence of the hidden curriculum, with the potential to improve quality of communication and care. Leora Branfield DayStephanie SaundersLeah SteinbergShiphra GinsburgChristine SoongCanadian Medical Education JournalarticleEducation (General)L7-991Medicine (General)R5-920ENCanadian Medical Education Journal (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Education (General) L7-991 Medicine (General) R5-920
spellingShingle	Education (General) L7-991 Medicine (General) R5-920 Leora Branfield Day Stephanie Saunders Leah Steinberg Shiphra Ginsburg Christine Soong “Get the DNR”: residents’ perceptions of goals of care conversations before and after an e-learning module
description	Background: Residents frequently lead goals of care (GoC) conversations with patients and families to explore patient values and preferences and to establish patient-centered care plans. However, previous work has shown that the hidden curriculum may promote physician-driven agendas and poor communication in these discussions. We previously developed an online learning (e-learning) module that teaches a patient-centered approach to GoC conversations. We sought to explore residents’ experiences and how the module might counteract the impact of the hidden curriculum on residents’ perceptions and approaches to GoC conversations. Methods: Eleven first-year internal medicine residents from the University of Toronto underwent semi-structured interviews before and after completing the module. Themes were identified using principles of constructivist grounded theory. Results: Prior to module completion, residents described institutional and hierarchical pressures to “get the DNR” (Do-Not-Resuscitate), leading to physician-centered GoC conversations focused on code status, documentation, and efficiency. Tensions between formal and hidden curricula led to emotional dissonance and distress. However, after module completion, residents described new patient-centered conceptualizations and approaches to GoC conversations, feeling empowered to challenge physician-driven agendas. This shift was driven by greater alignment of the new approach with their internalized ethical values, greater tolerance of uncertainty and complexity in GoC decisions, and improved clinical encounters in practice. Conclusion: An e-learning module focused on teaching an evidence-based, patient-centered approach to GoC conversations appeared to promote a shift in residents’ perspectives and approaches that may indirectly mitigate the influence of the hidden curriculum, with the potential to improve quality of communication and care.
format	article
author	Leora Branfield Day Stephanie Saunders Leah Steinberg Shiphra Ginsburg Christine Soong
author_facet	Leora Branfield Day Stephanie Saunders Leah Steinberg Shiphra Ginsburg Christine Soong
author_sort	Leora Branfield Day
title	“Get the DNR”: residents’ perceptions of goals of care conversations before and after an e-learning module
title_short	“Get the DNR”: residents’ perceptions of goals of care conversations before and after an e-learning module
title_full	“Get the DNR”: residents’ perceptions of goals of care conversations before and after an e-learning module
title_fullStr	“Get the DNR”: residents’ perceptions of goals of care conversations before and after an e-learning module
title_full_unstemmed	“Get the DNR”: residents’ perceptions of goals of care conversations before and after an e-learning module
title_sort	“get the dnr”: residents’ perceptions of goals of care conversations before and after an e-learning module
publisher	Canadian Medical Education Journal
publishDate	2021
url	https://doaj.org/article/d4473d4673484e03af93bbc990d1f9f4
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“Get the DNR”: residents’ perceptions of goals of care conversations before and after an e-learning module

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