title: Preparation of residents for death pronouncement: a sensitive and supportive method.
abstract: OBJECTIVE
  To identify factors associated with internal medicine interns' self-assessed competency in death pronouncement and to evaluate the effectiveness of a 10-minute death pronouncement module and pocket card guidelines.
  
  
  METHODS
  In June 2003 at the Birmingham VAMC, Alabama, 48 internal medicine interns completed a survey of medical school education, training, and experience in death pronouncement and a self-assessment of death pronouncement competency. In September 2003, 33 of the 48 interns completed a follow-up training/education survey and rated their post-intervention competency. Using chi-square and paired t-tests, we identified factors associated with variations among baseline and post-intervention variables and examined pre-post changes in self-assessed competency levels.
  
  
  RESULTS
  At baseline, less than 30% of the interns had medical school instruction in the process of death pronouncement. More than 70% reported needing basic instruction/close supervision. Post-intervention, close to 90% interns needed minimal or no assistance. Over 50% reported using pocket card guidelines. We found significant pre-post increases in mean rankings in each of the 5 self-assessed competencies (p < .001). Factors associated with differences in baseline and post-intervention assessments included medical school training/experience and use of the pocket card guidelines.
  
  
  CONCLUSIONS
  When interns began training, most had no instruction in death pronouncement and felt unprepared for this task. With brief instruction, pocket card guidelines, and 3-months experience, the majority of interns reported needing minimal/no assistance in pronouncing death. A larger sample from multiple sites is needed to confirm these findings.
authors.affiliation: Birmingham VAMC, University of Alabama, Birmingham, USA. amos.bailey@med.va.gov
authors.forename: F Amos
authors.initials: FA
authors.lastname: Bailey
authors.forename: Beverly Rosa
authors.initials: BR
authors.lastname: Williams
mesh_terms: D000407:Alabama; D002983:Clinical Competence; D003643:Death; D004521:Educational Measurement; D005260:Female; D017051:Hospice Care; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D008297:Male; D017410:Practice Guidelines as Topic; D017010:Reminder Systems; D013727:Terminal Care