End-of-life and palliative care curricula in internal medicine clerkships: a report on the presence, value, and design of curricula as rated by clerkship directors.
OBJECTIVE
End-of-life and palliative care (EOL/PC) education is a necessary component of undergraduate medical education. The extent of EOL/PC education in internal medicine (IM) clerkships is unknown. The purpose of this national study was to investigate the presence of formal EOL/PC curricula within IM clerkships; the value placed by IM clerkship directors on this type of curricula; curricular design and implementation strategies; and related barriers and resources.


METHODS
The Clerkship Directors in Internal Medicine conducted its annual survey of its institutional members in April 2012. The authors analyzed responses to survey items pertaining to formal EOL/PC curriculum and content using descriptive statistics. The authors used qualitative techniques to analyze free-text responses.


RESULTS
The response rate was 77.0% (94/122). Of those responding, 75.8% (69/91) believed such training should occur in the IM clerkship, and 43.6% (41/94) reported formal curricula in EOL/PC. Multiple instructional modalities were used to deliver this content, with the majority of programs dedicating four or more hours to the curriculum. Curricula covered a wide range of topics, and student assessment tools were varied. Most felt that students valued this education. The qualitative analysis revealed differences in the values clerkship directors placed on teaching EOL/PC within the IM clerkship.


CONCLUSIONS
Although many IM clerkship directors have implemented formal curricula in EOL/PC, a substantial gap remains between those who have implemented and those who believe it belongs in the clerkship. Time, faculty, cost, and competing demands are the main barriers to implementation.
Dr. Shaheen is clerkship director for the ambulatory internal medicine rotation and clinical associate professor of medicine, University of North Carolina, Chapel Hill, North Carolina. Dr. Denton is clerkship director, Primary Care Clerkship, Ochsner Clinical School-University of Queensland, New Orleans, Louisiana. Dr. Stratton is assistant dean, Assessment and Quality Management, Office of Medical Education, University of Kentucky College of Medicine, Lexington, Kentucky. Dr. Hoellein is clerkship director of internal medicine and associate professor of medicine, University of Kentucky Department of Internal Medicine, Lexington, Kentucky. Dr. Chretien is chief, Hospitalist Section, Washington DC VA Medical Center, and associate professor of medicine, George Washington University, Washington, DC.
Amy W
AW
Shaheen
G Dodd
GD
Denton
Terry D
TD
Stratton
Andrew R
AR
Hoellein
Katherine C
KC
Chretien
D000328:Adult; D001291:Attitude of Health Personnel; D002170:Canada; D002982:Clinical Clerkship / Q000379:methods* / Q000706:statistics & numerical data; D003479:Curriculum / Q000706:statistics & numerical data; D003625:Data Collection; D004504:Education, Medical, Undergraduate / Q000379:methods* / Q000706:statistics & numerical data; D005180:Faculty, Medical; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D013727:Terminal Care; D014481:United States