A medical resident inpatient hospice rotation: experiences with dying and subsequent changes in attitudes and knowledge.
OBJECTIVE
To evaluate intern experience in end-of-life care and self-assessed changes in attitude and knowledge, following a mandatory rotation on an inpatient hospice and in a nursing home.


METHODS
Twenty-seven interns enrolled in an internal medicine residency program completed a questionnaire examining experiences with dying patients, prior training in end-of-life care, and self-ratings of pertinent attitudes and knowledge. The questionnaire used a retrospective before and after design. Comparisons were evaluated using dependent two-tailed r-tests.


RESULTS
Prior training was largely limited to undergraduate didactic courses. Few interns had received formal training in symptom management. Most felt poorly prepared to care for terminally ill patients. Eighty-two percent of interns had previously cared for a dying patient only in acute care. Fifty-nine percent had never cared for a dying patient without intravenous fluids. Prior modeling of end-of-life care communication by attending physicians was uncommon. On a 5-point scale (strongly disagree-strongly agree) mean responses increased from 2.1 before-rotation to 3.0 after-rotation (p < 0.001) for the statement, "I feel as comfortable with a dying patient as I do with any other patient." Pain management knowledge increased from 2.0 before-rotation to 3.8 after-rotation (p < 0.001). Seventy-seven percent strongly agreed with the statement, "some training in care of terminally ill patients should be mandatory for all internists."


CONCLUSIONS
Prior experiences did not adequately prepare interns to deliver competent care. Significant improvements in attitude and knowledge were noted following the intervention. More hands-on clinical experiences in end-of-life care for residents are needed. Occasional didactic sessions will be inadequate.
Hallenbeck
J L
JL
Stanford School of Medicine Department of Medicine, Stanford University, VA Palo Alto Health Care System, Palo Alto, California 94304, USA. hanshan@mindspring.com
Bergen
M R
MR