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This article is the authors' final version prior to publication in Journal of Palliative Medicine, Volume 24, Issue 5, May 2021, Pages 647-648.

Final publication is available from Mary Ann Liebert, Inc., publishers



COVID-19 increased the need for goals of care (GOC) discussions in the Emergency Department (ED). Many Emergency Physicians (EPs) report no formal training in holding GOC discussions. COVID-19 created unique teaching challenges given social distancing requirements.


Eight teaching sessions were held using Zoom in March and April at an urban institution in the United States. Sessions were limited to 4-8 participants. They were comprised of a 30-minute lecture and 15 minutes of role-playing, in which providers read scripts to practice communication skills. The lecture introduced vocabulary and models to shape GOC discussions. Participants were invited to complete an eight-question survey about the effectiveness of the session and of virtual teaching.


40 of the Department’s 70 EPs participated (57%). 17 returned the survey (43%). Prior to the session, zero physicians were extremely comfortable having goals of care conversations, compared to 24% who ranked themselves as extremely comfortable afterwards. Prior to the session, 24% of physicians were not comfortable at all or not so comfortable leading goals of care conversations, compared to zero physicians who reported this after the session. 47% of participants rated the virtual platform as extremely effective for teaching these skills, and 71% said they had never received formal training about goals of care discussions.


There is a need for formal training in goals of care discussions for EPs. Patient-centered care based on patient goals and values benefits the patient, providers and healthcare overall. Zoom is an example of an effective virtual platform for teaching interpersonal skills.

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