title: Formal Academic Training on Ethics May Address Junior Physicians' Needs.
abstract: Surveys have highlighted perceived deficiencies among ICU residents in end-of-life care, symptom control, and confidence in dealing with dying patients. Lack of formal training may contribute to the failure to meet the needs of dying patients and their families. The objective of this study was to evaluate junior intensivists' perceptions of triage and of the quality of the dying process before and after formal academic training.
  
  
  
  Formal training on ethics was implemented as a part of resident training between 2007 and 2012. A cross-sectional survey was performed before (2007) and after (2012) this implementation. This study included 430 junior intensivists who were interviewed during these periods.
  
  
  
  More responders attended a dedicated training course on ethics and palliative care during 2012 (38.5%) than during 2007 (17.4%; P < .0001). During 2012, respondents reported less discomfort and fewer uncertainties regarding decisions about limiting life-sustaining treatment (17.7% vs 39.1% in 2007; P < .0001) or the triage process (48.5% vs 69.4% in 2007; P < .0001). Factors independently associated with positive perceptions of the dying process were physician's age (OR, 1.19 per year; 95% CI, 1.09-1.25) and male sex (OR, 1.61; 95% CI, 1.05-2.47). Conversely, anxiety about family members' reactions (OR, 0.58; 95% CI, 0.0.37-0.87) and lack of training (OR, 0.29; 95% CI, 0.17-0.50) were associated with negative perceptions of this process.
  
  
  
  Formal training dedicated to ethics and palliative care was associated with a more comfortable perception of the dying process. This training may decrease the uncertainty and discomfort of junior intensivists in these situations.
authors.affiliation: Medical-Surgical Intensive Care Unit, Saint-Etienne University Hospital, Saint-Etienne, France. Electronic address: michael.darmon@chu-st-etienne.fr.
authors.forename: Michael
authors.initials: M
authors.lastname: Darmon
authors.affiliation: Medical Intensive Care Unit and FAMIREA Study Group, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Ducos
authors.affiliation: Medical Intensive Care Unit and FAMIREA Study Group, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Isaline
authors.initials: I
authors.lastname: Coquet
authors.affiliation: Biostatistic Department, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Resche-Rigon
authors.affiliation: Medical Intensive Care Unit and FAMIREA Study Group, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Frederic
authors.initials: F
authors.lastname: Pochard
authors.affiliation: Medical Intensive Care Unit and FAMIREA Study Group, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Paries
authors.affiliation: Medical Intensive Care Unit and FAMIREA Study Group, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Nancy
authors.initials: N
authors.lastname: Kentish-Barnes
authors.affiliation: Medical Intensive Care Unit and FAMIREA Study Group, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Marine
authors.initials: M
authors.lastname: Chaize
authors.affiliation: Medical Intensive Care Unit and FAMIREA Study Group, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Faculté de Médecine, Université Paris-Diderot, Sorbonne-Paris-Cité, Paris, France.
authors.forename: Benoit
authors.initials: B
authors.lastname: Schlemmer
authors.affiliation: Medical Intensive Care Unit and FAMIREA Study Group, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Faculté de Médecine, Université Paris-Diderot, Sorbonne-Paris-Cité, Paris, France.
authors.forename: Elie
authors.initials: E
authors.lastname: Azoulay
mesh_terms: D000328:Adult; D001293:Attitude to Death; D003430:Cross-Sectional Studies; D005260:Female; D005602:France; D006801:Humans; D007396:Internship and Residency / Q000379:methods; D008297:Male; D008505:Medical Staff, Hospital / Q000193:education / Q000523:psychology; D020380:Needs Assessment; D010166:Palliative Care / Q000941:ethics*; D058996:Quality Improvement; D013663:Teaching / Q000592:standards; D013727:Terminal Care / Q000941:ethics*
keywords: ICU; curriculum; education; internship and residency; terminal care