Medicine residents' self-perceived competence in end-of-life care.
OBJECTIVE
Internal medicine residents frequently provide end-of-life care, yet feel inadequately trained and uncomfortable providing this care, despite efforts to improve end-of-life care curricula. Understanding how residents' experiences and attitudes affect their perceived competence in providing end-of-life care is important for targeting educational interventions.


METHODS
Medicine residents (74) at the University of Washington and Medical University of South Carolina enrolled in a trial investigating the efficacy of a communication skills intervention to improve end-of-life care. On entry to the study in the fall of 2007, residents completed a questionnaire assessing their prior experiences, attitudes, and perceived competence with end-of-life care. Multivariate regression analysis was performed to assess whether attitudes and experiences with end-of-life care were associated with perceived competence, controlling for gender, race/ethnicity, training year, training site, and personal experience with death of a loved one.


RESULTS
Residents had substantial experience providing end-of-life care. In an adjusted multivariate model including attitudes and clinical experience in end-of-life care as predictors, only clinical experience providing end-of-life care was associated with self-perceived competence (P=.015).


CONCLUSIONS
Residents with more clinical experience during training had greater self-perceived competence providing end-of-life care. Increasing the quantity and quality of the end-of-life care experiences during residency with appropriate supervision and role modeling may lead to enhanced skill development and improve the quality of end-of-life care. The results suggest that cultivating bedside learning opportunities during residency is an appropriate focus for educational interventions in end-of-life care education.
Division of Pulmonary and Critical Care, University of Washington, Seattle, Washington 98104, USA. mebillin@u.washington.edu
Martha E
ME
Billings
J Randall
JR
Curtis
Ruth A
RA
Engelberg
D000328:Adult; D000704:Analysis of Variance; D002983:Clinical Competence / Q000592:standards*; D003625:Data Collection; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000193:education / Q000592:standards*; D007396:Internship and Residency / Q000592:standards*; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D010166:Palliative Care / Q000592:standards*; D012647:Self-Assessment; D013022:South Carolina; D013223:Statistics as Topic; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000592:standards*; D014861:Washington