Advance care planning (ACP) is a process which includes patients discussing their values about health care choices with health care professionals. Evidence suggests that the process of ACP is instrumental in tailoring health care plans to patients’ needs, reducing patient and family uncertainties and distress, and decreasing unwanted and harmful medical cares. ACP requires skillful communication, and frameworks exist to guide communication, however a competency-based assessment method to evaluate trainees in the ACP discussion skills is lacking.
The objectives of our study are to validate a novel assessment tool, the ACP – Clinical Evaluation Exercise (ACP-CEx), to facilitate assessment of trainee-led ACP discussions with oncology patients in the ambulatory setting based on the Competency-Based Medical Education (CBME) model.
We have developed the ACP-CEx based on the Boston Serious Illness Conversation Guideline (SICG) framework, and on the key milestones to achieve ACP skills as an Entrustable Physician Activity (EPA). The validation process follows Kane’s framework. Ten volunteer trainees and twenty volunteer preceptors will be recruited from two academic cancer centres. Each trainee will be assigned to a volunteer patient and be asked to discuss ACP in an outpatient oncology clinic. The session will be videotaped. Trainees will complete a self-assessment survey. Within two weeks of the discussion, the videos will be sent to an assigned preceptor, where all preceptors from one centre will independently score the videos of all trainees from the other centre, using the ACP-CEx tool (experimental tool) as well as the Calgary-Cambridge Guide (reference tool). After three months, the preceptors will watch the videos again to assess the same trainees a second time. The scores generated will be analyzed for correlation between the scores from the ACP-CEx and from the Calgary-Cambridge Guide; intra- and inter-rater reliability; and comparison with trainee self-assessment scores and open-ended, qualitative feedback.