End-of-life care education in internal medicine residency programs: an interinstitutional study

Patricia B Mullan, David E Weissman, Bruce Ambuel, Charles von Gunten
Journal of Palliative Medicine 2002, 5 (4): 487-96

BACKGROUND: Integrating end-of-life care (EOL) education into medical residency programs requires knowledge of what programs currently teach and what residents learn.

OBJECTIVE: Evaluate EOL teaching content and practices in internal medicine residency programs and the EOL knowledge of their faculty and residents.

DESIGN: An interinstitutional pilot study. We examined patterns of EOL education, discerned from program directors' responses to structured surveys of institutional teaching and evaluation practices, and EOL knowledge, derived from the performance of faculty and residents on a 36-item knowledge examination.

SUBJECTS: Program directors, faculty, and residents at 32 accredited U.S. internal medicine residency programs.

RESULTS: Although all programs cited inclusion of some EOL education, expected EOL domains were not systematically taught or assessed. Pain assessment and treatment training was required in only 60% of programs. Even fewer programs required instruction on nonpain symptoms (<30%) or hospice and nonhospital care settings (22%). EOL assessment depends primarily on faculty's general ratings of residents' global competency; few programs use knowledge examinations or structured skill assessments. Directors identified barriers and support for improving education. On the knowledge examination, the mean score of residents increased across training levels (F = 21.7, p < .001), and the mean score of faculty was higher than residents' (57.6%: 48.9%, t = 51.6, p < .001).

CONCLUSIONS: Existing internal medicine residency education lacks training in critical EOL care domains. Residency programs need additional training for residents and teaching faculty in EOL content and skills, with assessment practices that demonstrate competencies have been acquired. Program directors perceive institutional support for making these changes.

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