ACGME requirements for end-of-life training in selected residency and fellowship programs: a status report.
BACKGROUND
National recommendations have been developed for physicians' end-of-life (EOL) education. No comprehensive assessment has been done to examine postgraduate (residency and fellowship) EOL training.


METHODS
The authors reviewed the EOL content for 46 specialties in postgraduate training programs that affect the care of seriously ill and dying patients, using data from the 2000/2001 AMA Graduate Medical Education Directory.


RESULTS
Internal medicine, geriatrics, and neurology contained the most comprehensive EOL requirements. Most surgical specialties contained no EOL requirement except ethics. Ethics (n = 25) and psychosocial care (n = 22) were the most common EOL domains mandated, although specific EOL content was not specified. Training in EOL communication (n = 1), personal awareness (n = 3), and EOL clinical experiences (n = 5) were the least often required instructional domains. Instruction in pain assessment and management was required in only one surgical specialty.


CONCLUSIONS
The lack of comprehensive EOL training requirements may help explain the known problems in physicians' EOL care. Major reform in EOL requirements is needed at the level of residency review committees.
Weissman
David E
DE
Palliative Care Program, Medical College of Wisconsin, c/o Froedtert Hospital, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA. dweissmn@mcw.edu
Block
Susan D
SD
D001293:Attitude to Death; D003479:Curriculum / Q000592:standards*; D005257:Fellowships and Scholarships; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D013727:Terminal Care; D014481:United States