title: Palliative educational outcome with implementation of PEACE tool integrated clinical pathway.
abstract: BACKGROUND
  House officers frequently lack basic competency in end-of-life care. Few studies have evaluated educational interventions deliberately utilizing physicians' learning strategies, particularly in the context of a concomitant effort at modification of practice patterns.
  
  
  METHODS
  Prospective controlled trial utilizing pre-intervention and post-intervention cross-sectional surveys.
  
  
  METHODS
  Internal medicine residents at a university hospital in their first, second, and third years of training.
  
  
  METHODS
  A 25-item survey modified from previously published instruments.
  
  
  METHODS
  Residents in the intervention group utilized an experiential learning intervention (integrated, end-of-life clinical pathway: PEACE Tool). The control group delivered care in a standard fashion.
  
  
  METHODS
  SURVEY item and test responses were tabulated and pair-wise comparisons between group means evaluated statistically using two-sample t tests.
  
  
  RESULTS
  Fifty-four internal medicine residents (n = 24, first-year; n = 17, second-year; and n = 13, third-year) completed the survey. Pre-intervention mean scores on a 16-item knowledge scale were 7.4 (46% correct) for first-year, 8.1 (51%) for second-year, and 9.2 (58%) for third-year residents. Eighteen first-year residents participated in the intervention phase (8 in the intervention, 10 in the control). Mean overall knowledge scores were 46% higher in the intervention group compared to the control group (11.8 versus 8.1 p < 0.001).
  
  
  CONCLUSIONS
  A time-effective, practice-based strategy led to a significant improvement in knowledge of end-of-life care. Prior to implementation of this strategy competency in end-of-life care was suboptimal among internal medicine residents, in spite of desirable attitudes. Factual knowledge improved slightly with standard, pre-intervention training and experience.
authors.affiliation: Division of General Internal Medicine, Section of Palliative Care, University of Virginia, Charlottesville, VA, USA. okon.tomasz@marshfieldclinic.org
authors.forename: Tomasz R
authors.initials: TR
authors.lastname: Okon
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Evans
authors.forename: Carlos F
authors.initials: CF
authors.lastname: Gomez
authors.forename: Leslie J
authors.initials: LJ
authors.lastname: Blackhall
mesh_terms: D000328:Adult; D002983:Clinical Competence; D019091:Critical Pathways / Q000706:statistics & numerical data*; D004521:Educational Measurement; D006785:Hospitals, University; D006801:Humans; D007388:Internal Medicine / Q000193:education* / Q000592:standards; D007396:Internship and Residency / Q000592:standards*; D010166:Palliative Care / Q000592:standards*; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000592:standards*; D014481:United States