To develop and evaluate a goals of care communication curriculum for neurology residents.

Neurology residents care for patients facing life-altering and life-limiting diseases. It is crucial that residents are proficient in the principles of palliative care, including counseling patients and their families regarding goals of care. We previously conducted a needs assessment with neurology residents to identify barriers to effective goals of care conversations. We designed a curricular intervention to address these barriers aimed at increasing residents’ confidence and skill leading goals of care conversations.

We developed two 3-hour workshops based on themes identified from the needs assessment. Topics included fundamental physician-patient communication skills, counseling surrogate decisionmakers, and tenets of prognostication. We conducted resident and patient surveys and direct observations of resident-patient interactions to evaluate the impact of the curriculum.

Residents reported a significant increase in their confidence practicing fundamental communication skills and goals of care communication skills. Observed resident-patient interactions showed significant improvement in fundamental communication skills. However, there was no significant impact on patient perception of resident communication skills in the three months following the intervention.

A short, learner-centric, targeted curricular intervention improved neurology residents’ confidence in goals of care communication and improved their skills as judged by trained observers. The lack of significant impact on patient perception of resident skill may reflect inadequate sensitivity of the Communication Assessment Tool to detect differences in patient perception of nuanced conversations. Notably, greater improvements were seen in fundamental communication skills compared to skills related to goals of care, suggesting that a more intensive educational method such as individualized coaching may be required to improve these. Our next steps include enhancing the next version of the curriculum using the Serious Illness Conversation Guide, and involving neurology faculty educators in resident feedback through a longitudinal coaching program.