A controlled trial of a short course to improve residents' communication with patients at the end of life.
OBJECTIVE
High-quality palliative care requires physicians who communicate effectively, yet many do not receive adequate training. Leading efforts to demonstrate the effectiveness of such training have involved time-intensive programs that included primarily attending physicians, which have been conducted outside of the United States. The goal was to evaluate the effect of a short course to improve residents' communication skills delivering bad news and eliciting patients' preferences for end-of-life care.


METHODS
This prospective trial enrolled internal medicine residents at Duke University Medical Center from 1999 to 2001. The course consisted of small-group teaching with lecture, discussion, and role-play. The outcome measure was observed communication skills delivering bad news and eliciting patients' preferences for end-of-life treatment, assessed via audio-recorded standardized patient encounters before and after receiving the intervention.


RESULTS
Thirty-seven residents received the intervention and 19 were in the control group. Residents attending the course demonstrated statistically significant increases in their overall skill ratings in the delivery of bad news, with improvement in the specific areas of information giving and responding to emotional cues. Although cumulative scores for discussions about patient preferences for treatment did not increase, residents demonstrated enhanced specific skills including discussing probability, presenting clinical scenarios, and asking about prior experience with end-of-life decision making.


CONCLUSIONS
A relatively short, intensive course can improve the end-of-life communication skills of U.S. medical residents.
Alexander
Stewart C
SC
Durham VA Medical Center, North Carolina, USA. alexa054@mc.duke.edu
Keitz
Sheri A
SA
Sloane
Richard
R
Tulsky
James A
JA
D000328:Adult; D032722:Advance Care Planning; D003142:Communication; D003162:Competency-Based Education; D003479:Curriculum; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency / Q000592:standards*; D008297:Male; D009657:North Carolina; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011361:Professional Competence; D015397:Program Evaluation; D011446:Prospective Studies; D012577:Schools, Medical; D013727:Terminal Care / Q000523:psychology / Q000592:standards*; D014342:Truth Disclosure