Educating medical residents in end-of-life care: insights from a multicenter survey.
BACKGROUND
Physicians play a key role in the provision of quality end-of-life (EOL) care but often lack requisite knowledge and skills. Residency programs must ensure training in palliative/EOL care to address this gap.


OBJECTIVE
To guide the development of curricula, we assessed internal medicine residents' attitudes, knowledge, perceived competence, and learning priorities in EOL care.


METHODS
Cross-sectional, self-administered, descriptive survey using a convenience sample.


METHODS
Internal medicine residents at five universities across Canada.


RESULTS
Of a total of 318 internal medicine residents, 185 (58%) participated in the survey. The majority (81.7%) agreed learning from dying patients was meaningful although 48.1% felt guilty, and 40.6% a failure at least sometimes after a patient's death. Two thirds had provided care to more than 10 dying patients. Most (73%) had conducted at least 3 family meetings; 26.7% were never observed. Mean self-assessed preparedness to provide EOL care was 6.1 +/- 2 (scale 0-10) and mean comfort level 3.2 +/- 0.8 (scale 0-5). Residents reported more than average competence in 50% of EOL competencies listed with record keeping highest (3.6 +/- 0.7) and use of nonpharmacologic interventions for pain lowest (2.2 +/- 0.8). Priority for learning was rated above average for all EOL competencies listed with use of opioids for management of pain highest (4.1 +/- 0.9) and discussing euthanasia lowest (3.1 +/- 1.3).


CONCLUSIONS
Internal medicine residents value opportunities to learn from dying patients but often lack supervision and experience emotional distress. Comparing residents' attitudes, perceptions of competence, and learning priorities provide insights into why certain EOL competencies are more challenging to teach and can guide development of meaningful educational experiences.
Department of Oncology, Queen's University, Kingston, Ontario, Canada.
Cori
C
Schroder
Daren
D
Heyland
Xuran
X
Jiang
Graeme
G
Rocker
Peter
P
Dodek
D000328:Adult; D001955:British Columbia; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D003479:Curriculum; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D008297:Male; D009674:Nova Scotia; D009864:Ontario; D010166:Palliative Care; D016730:Program Development; D013727:Terminal Care