The palliative care clinical evaluation exercise (CEX): an experience-based intervention for teaching end-of-life communication skills.
OBJECTIVE
To pilot test the "Palliative Care Clinical Evaluation Exercise (CEX)," a new experience-based intervention to teach communication skills in giving bad news and discussing code status. The intervention allows faculty to observe, evaluate, and give feedback to housestaff in their discussions with patients and families.


METHODS
In 2002-03, the intervention was piloted among 60 first-year residents in the categorical Internal Medicine Residency Programs at the University of Pittsburgh. The authors collected feasibility measurements at the time of intervention, and interns' attitudes were measured before and one week after intervention and at the end of the intern year.


RESULTS
Forty-four residents (73%) completed the intervention. Discussions averaged a total of 49.5 minutes (SD 24.1), divided among 12.7 minutes (SD 7.5) for prediscussion counseling between the resident and faculty observer, 25.6 minutes (SD 16.1) for the resident-patient discussion, and 12.1 minutes (SD 5.7) for postdiscussion feedback. Residents rated the Palliative Care CEX favorably (>3 on a five-point scale) on ease of arranging the exercise, educational value, quality of the experience, effect on their comfort with discussions, importance to their education, and value of preceptor feedback. Self-ratings of communication competence showed improvement one week after the intervention.


CONCLUSIONS
The Palliative Care CEX is feasible and positively valued by residents. The findings from this initial pilot study support the value of further efforts to refine the intervention, to confirm its feasibility in other settings, and to validate its use as an educational and assessment tool.
Division of Cancer Prevention, National Cancer Institute, Executive Plaza North, Room 4097, 6130 Executive Boulevard, Bethesda, MD 20852, USA. hanp@mail.nih.gov
Paul K J
PK
Han
Lisa B
LB
Keranen
Dianne A
DA
Lescisin
Robert M
RM
Arnold
D000223:Adaptation, Psychological; D000368:Aged; D001291:Attitude of Health Personnel; D001293:Attitude to Death; D002983:Clinical Competence; D004521:Educational Measurement; D005180:Faculty, Medical; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D008297:Male; D010166:Palliative Care; D010817:Physician-Patient Relations; D010865:Pilot Projects; D018794:Problem-Based Learning / Q000379:methods; D013727:Terminal Care / Q000523:psychology*; D014342:Truth Disclosure