Palliative and end-of-life educational practices in US pulmonary and critical care training programs.
OBJECTIVE
To describe educational features in palliative and end-of-life care (PEOLC) in pulmonary/critical care fellowships and identify the features associated with perceptions of trainee competence in PEOLC.


METHODS
A survey of educational features in 102 training programs and the perceived skill and comfort level of trainees in 6 PEOLC domains: communication, symptom control, ethical/legal, community/institutional resources, specific syndromes, and ventilator withdrawal. We evaluated associations between perceived trainee competence/comfort in PEOLC and training program features, using regression analyses.


RESULTS
Fifty-five percent of program directors (PDs) reported faculty with training in PEOLC; 30% had a written PEOLC curriculum. Neither feature was associated with trainee competence/comfort. Program directors and trainees rated bedside PEOLC teaching highly. Only 20% offered PEOLC rotations; most trainees judged these valuable. Most PDs and trainees reported that didactic teaching was insufficient in communication, although sufficient teaching of this was associated with perceived trainee competence in communication. Perceived trainee competence in managing institutional resources was rated poorly. Program directors reporting significant barriers to PEOLC education also judged trainees less competent in PEOLC. Time constraint was the greatest barrier.


CONCLUSIONS
This survey of PEOLC education in US pulmonary/critical care fellowships identified associations between certain program features and perceived trainee skill in PEOLC. These results generate hypotheses for further study.
Pulmonary/Critical Care Division, Stony Brook University, Stony Brook, NY. Electronic address: paul.richman@stonybrookmedicine.edu.
Paul S
PS
Richman
Pulmonary Critical Care Division, Veterans Affairs Healthcare of Greater Los Angeles, Los Angeles, CA. Electronic address: howardsaft@hotmail.com.
Howard L
HL
Saft
Department of Preventative Medicine, Stony Brook University, Stony Brook University, Stony Brook, NY. Electronic address: catherine.messina@stonybrookmedicine.edu.
Catherine R
CR
Messina
Division of Pulmonary & Critical Care Medicine and Allergic & Immunologic Diseases, University Hospital Building, New Jersey Medical School, Newark, NJ, 07103. Electronic address: bermanar@njms.rutgers.edu.
Andrew R
AR
Berman
Hoag Memorial Hospital, Newport Beach, and the University of California at Los Angeles, Newport Beach, CA. Electronic address: paul.selecky@hoag.org.
Paul A
PA
Selecky
Kaiser Permanente Northwest, Sunnyside Hospital, Clackamas, OR. Electronic address: Richard.A.Mularski@kpchr.org.
Richard A
RA
Mularski
Lehigh Valley Medical Center, Allentown, PA. Electronic address: daniel.ray@lvh.com.
Daniel E
DE
Ray
Medical University of South Carolina, HSC-17040, Charleston, SC. Electronic address: fordd@musc.edu.
Dee W
DW
Ford
D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003422:Critical Care; D003479:Curriculum; D004503:Education, Medical, Graduate / Q000379:methods* / Q000592:standards; D005257:Fellowships and Scholarships; D005260:Female; D006801:Humans; D008297:Male; D010166:Palliative Care; D012044:Regression Analysis; D013727:Terminal Care; D014481:United States
End-of-life care; Palliative care; postgraduate medical education; pulmonary/critical care training