End-of-life curriculum reform: outcomes and impact in a follow-up study of internal medicine residency programs.

BACKGROUND: In 1998 we initiated a pilot project to evaluate the feasibility of recruiting and training internal medicine residency programs in methods designed to enhance and integrate end-of-life (EOL) instruction and assessment into their curriculum.

OBJECTIVE: To evaluate participants' assessment of the training program and the 12-month impact of the training on the 32 residency programs' EOL teaching.

DESIGN: Prospective multi-institutional study.

MEASUREMENT AND RESULTS: After participating in training, all participants agreed/strongly agreed that the skills-related objectives of the training were met. Mean ratings of intention to continue with the program were consistent across trainees representing different academic ranks (F = 2.8, p = 0.07), levels of experience in EOL education (F = 1.3, p = 0.28), and involvement in other national EOL training programs (F = 1.5, p = 0.23). Twelve months after training, most programs (78%) continued with the project and had initiated EOL curriculum reform in seven key EOL domains.).

CONCLUSIONS: The study suggests that focused training in EOL teaching methods and institutional change strategies can facilitate EOL curriculum reform.