title: Do residents need end-of-life care training?
abstract: OBJECTIVE
  As medical education evolves, emphasis on chronic care management within the medical curriculum becomes essential. Because of the consistent lack of appropriate end-of-life care training, far too many patients die without the benefits of hospice care. This study explores the association between physician knowledge, training status, and level of comfort with hospice care referral of terminally ill patients.
  
  
  METHODS
  In 2011, anonymous surveys were distributed to physicians in postgraduate years 1, 2, and 3; fellows; hospital attending physicians; specialists; and other healthcare professionals in five hospitals of a large health system in New York. Demographic comparisons were performed using χ2 and Fisher's exact tests. Spearman correlations were calculated to determine if professional status and experience were associated with comfort and knowledge discussing end-of-life topics with terminal patients.
  
  
  RESULTS
  The sample consisted of 280 participants (46.7% response rate). Almost a quarter (22%) did not know key hospice referral criteria. Although 88% of respondents felt that knowledge of hospice care is an important competence, 53.2% still relinquished advance directives discussion to emergency room (ER) physicians. Fear of patient/family anger was the most frequently reported hospice referral barrier, although 96% of physicians rarely experienced reprisals. Physician comfort level discussing end-of-life issues and hospice referral was significantly associated with the number of years practicing medicine and professional status.
  
  
  CONCLUSIONS
  Physicians continue to relinquish end-of-life care to ER staff and palliative care consultants. Exploring unfounded and preconceived fears associated with hospice referral needs to be integrated into the curriculum, to prepare future generations of physicians. Medical education should focus on delivering the right amount of end-of-life care training, at the right time, within the medical school and residency curriculum.
authors.affiliation: North Shore-LIJ Health System,Great Neck, New York.
authors.forename: Agata Marszalek
authors.initials: AM
authors.lastname: Litauska
authors.affiliation: North Shore-LIJ Health System,Great Neck, New York.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Kozikowski
authors.affiliation: North Shore-LIJ Health System,Great Neck, New York.
authors.forename: Christian N
authors.initials: CN
authors.lastname: Nouryan
authors.affiliation: North Shore-LIJ Health System,Great Neck, New York.
authors.forename: Myriam
authors.initials: M
authors.lastname: Kline
authors.affiliation: North Shore-LIJ Health System,Great Neck, New York.
authors.forename: Renee
authors.initials: R
authors.lastname: Pekmezaris
authors.affiliation: North Shore-LIJ Health System,Great Neck, New York.
authors.forename: Gisele
authors.initials: G
authors.lastname: Wolf-Klein
mesh_terms: D000328:Adult; D003144:Communication Barriers; D003430:Cross-Sectional Studies; D003479:Curriculum / Q000592:standards / Q000639:trends; D004503:Education, Medical, Graduate / Q000592:standards* / Q000639:trends; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D017051:Hospice Care / Q000706:statistics & numerical data*; D006801:Humans; D007396:Internship and Residency / Q000592:standards* / Q000639:trends; D008297:Male; D008875:Middle Aged; D009518:New York; D010817:Physician-Patient Relations; D011368:Professional-Family Relations; D012017:Referral and Consultation / Q000706:statistics & numerical data; D013727:Terminal Care / Q000379:methods / Q000592:standards; D055815:Young Adult