Skip to content

Training in Serious Illness Conversations Boosts Confidence of Students, Interns

Key findings

  • The Ariadne Labs Serious Illness Care Program includes a structured guide with specific, tested vocabulary for conducting serious illness conversations
  • At Massachusetts General Hospital, the program was adapted for the training of 81 final-year medical students and 156 first-year residents over the course of a year
  • Learner satisfaction was high (86%–91%), and 94% of students supported offering the training to their peers, suggesting the concepts are not too advanced for that learner level
  • Among both students and residents, confidence significantly increased in all communication domains queried after the session
  • The research team plans to adapt the training for online delivery

Ariadne Labs, a joint center of Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health, introduced the Serious Illness Care Program (SICP) in 2015 to improve conversations with seriously ill patients about their goals and values. The core of the program is a simple conversation guide.

Multiple studies have shown that training practicing clinicians to use the SICP improves the number, timing, quality, and accessibility of serious illness conversations and reduces patient anxiety and depression.

Juliet Jacobsen, MD, DPH, attending physician in the Division of Palliative Care and Geriatric Medicine at Massachusetts General Hospital, and colleagues recently adapted the training for medical students and interns. In the Journal of Pain and Symptom Management, they report it improved trainees' confidence in conducting serious illness conversations and the likelihood that residents would document such discussions in the electronic health record (EHR).


In 13 workshops conducted over a year, the team trained 81 final-year medical students and 156 first-year residents. The standard Ariadne program is available under a Creative Commons license that allows modification, and Mass General added two training emphases: the communication skills needed to explore a patient's prognostic awareness and respond to emotion.

The workshops lasted 2.5 hours:

  • First hour—Large group session consisting of a brief guided reflection on participants' personal experiences with serious illness conversations, presentation of the evidence base for the SICP, orientation to the structure of the Serious Illness Conversation Guide (SICG), demonstration of how to use the SICG with a patient and, for resident training, a brief orientation on how to document conversations in the EHR
  • Remaining 90 minutes—Role play in groups composed of five to seven learners, a standardized patient, and one or two palliative care–trained facilitators who gave feedback

Immediately after the workshop, learners were asked to rate their confidence in specific communication skills "before participating in the training" and "after participating in the training."


63 students and 69 residents provided anonymous qualitative and quantitative feedback:

  • 86% of students and 91% of residents rated the session "very good" or "excellent"
  • 94% of students would recommend the training to their peers, and 97% of residents intended to apply it to their practice


Self-confidence improved from baseline in all domains queried (P<0.001 for all):

Students (seven-point Likert scale)

  • Responding to emotions—an average increase of 0.6 points
  • Exploring patient hopes—an average increase of 1.6 points
  • Exploring patient worries—an average increase of 1.7 points
  • Assessing patient prognostic awareness—an average increase of 1.4 points
  • Delivering prognostic information—an average increase of 1.4 points
  • Eliciting patient priorities—an average increase of 1.6 points

Residents (five-point Likert scale)

  • Ability to use the conversation guide—average increase 2.3 points
  • Assessing patient prognostic awareness—an average increase of 1.6 points
  • Responding to emotions—an average increase of 0.7 point
  • Eliciting patient values and priorities—an average increase of 1.3 points

Free-text feedback indicated the three most valued aspects of the training were the conversation guide, as its structure demystified challenging conversations; the language for responding to emotion; and the concept of eliciting patients' hopes and worries, which was new to many learners.


As part of implementing the SICP hospital-wide, the team partnered with Epic Systems to activate a template in the EHR advance care planning navigator that mirrors the structure of the conversation guide. Clinicians can quickly scan prior conversations for relevant patient information and build on other clinicians' prior discussions.

For 12 months after the trainings, the researchers tracked resident documentation of serious illness conversations in the EHR template. Compared with the prior year, resident-led documentation increased 4.5-fold.

Next Steps

Given the profound shift in educational practices during the COVID-19 pandemic, the research group plans to adapt the training to online learning platforms. They hope larger, multisite studies will assess the durability of the training effect on clinician behavior and, ultimately, whether it influences patient quality of life.

of first-year residents intend to apply their training in serious illness conversations to their practice

of final-year medical students who had training in serious illness conversations supported offering it to their peers

increase in resident-led documentations of serious illness conversations after residents were trained in how to conduct them

Learn about the Division of Palliative Care and Geriatric Medicine

Refer a patient to the Division of Palliative Care and Geriatric Medicine

Related topics


Massachusetts General Hospital researchers report that when palliative care physicians were embedded in the ED early in COVID-19, they had a goal of care conversation with 59% of acutely ill patients they saw in collaboration with emergency physicians, and 61% of conversations included discussion of prognosis.


Emily L. Aaronson, MD, MPH, Jeffrey L. Greenwald, MD, and colleagues conducted a randomized pilot trial in which emergency department social workers had serious illness conversations with 66% of older adults with potential palliative care needs—on top of their usual duties—and 77% of patients appreciated the talk.