Training Residents in Advance Care Planning: A Task-Based Needs Assessment Using the 4-Component Instructional Design

Thomas Fassier*, Amandine Rapp, Jan-Joost Rethans, Mathieu Nendaz, Naïke Bochatay

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background: Residents may learn how to perform advance care planning (ACP) through informal curriculum. Task-based instructional designs and recent international consensus statements for ACP provide opportunities to explicitly train residents, but residents' needs are poorly understood.

Objective: We assessed residents' training needs in ACP at the Geneva University Hospitals in Geneva, Switzerland.

Methods: Qualitative data were collected and analyzed iteratively between December 2017 and September 2019. Transcripts were coded using both a deductive content analysis based on the 4-Component Instructional Design (4C/ID) model and an inductive thematic analysis.

Results: Out of 55 individuals contacted by email, 49 (89%) participated in 7 focus groups and 10 individual interviews, including 19 residents, 18 fellows and attending physicians, 4 nurses, 1 psychologist, 1 medical ethics consultant, 3 researchers, and 3 patients. Participants identified 3 tasks expected of residents (preparing, discussing, and documenting ACP) and discussed why training residents in ACP is complex. Participants described knowledge (eg, prognosis), skills (eg, clinical and ethical reasoning), and attitudes (eg, reflexivity) that residents need to become competent in ACP and identified needs for future training. In terms of the 4C/ID, these needs revolved around: (1) learning tasks (eg, workplace practice, simulated scenarios); (2) supportive information (eg, videotaped worked examples, cognitive feedback); (3) procedural information (eg, ACP pocket-sized information sheet, corrective feedback); and (4) part-task practice (eg, rehearsal of communication skills, simulation).

Conclusions: This study provides a comprehensive description of tasks and competencies to train residents in ACP.

Original languageEnglish
Pages (from-to)534-547
Number of pages14
JournalJournal of Graduate Medical Education
Issue number4
Publication statusPublished - Aug 2021


  • Advance Care Planning
  • Curriculum
  • Health Personnel
  • Humans
  • Internship and Residency
  • Needs Assessment

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