title: Palliative Care Education in Emergency Medicine Residency Training: A Survey of Program Directors, Associate Program Directors, and Assistant Program Directors.
abstract: Emergency medicine (EM) residents perceive palliative care (PC) skills as important and want training, yet there is a general lack of formal PC training in EM residency programs. A clearer definition of the PC educational needs of EM trainees is a research priority.
  
  
  
  To assess PC competency education in EM residency programs.
  
  
  
  This was a mixed-mode survey of residency program directors, associate program directors, and assistant program directors at accredited EM residency programs, evaluating four educational domains: 1) importance of specific competencies for senior EM residents, 2) senior resident skills in PC competencies, 3) effectiveness of educational methods, and 4) barriers to training.
  
  
  
  Response rate was 50% from more than 100 residency programs. Most respondents (64%) identified PC competencies as important for residents to learn, and 59% reported that they teach7 PC skills in their residency program. In Domains 1 and 2, crucial conversations, management of pain, and management of the imminently dying had the highest scores for importance and residents' skill. In Domain 3, bedside teaching, mentoring from hospice and palliative medicine faculty, and case-based simulation were the most effective educational methods. In Domain 4, lack of PC expertise among faculty and lack of interest by faculty and residents were the greatest barriers. There were differences between competency importance and senior resident skill level for management of the dying child, withdrawal/withholding of nonbeneficial interventions, and ethical/legal issues.
  
  
  
  There are specific barriers and opportunities for PC competency training and gaps in resident skill level. Specifically, there are discrepancies in competency importance and residency skill in the management of the dying child, nonbeneficial interventions, and ethical and legal issues that could be a focus for educational interventions in PC competency training in EM residencies.
authors.affiliation: Department of Emergency Medicine, University of Missouri-Columbia, Columbia, Missouri, USA. Electronic address: chaddkraus@gmail.com.
authors.forename: Chadd K
authors.initials: CK
authors.lastname: Kraus
authors.affiliation: Department of Emergency Medicine, Lehigh Valley Health Network, Allentown, Pennsylvania, USA.
authors.forename: Marna R
authors.initials: MR
authors.lastname: Greenberg
authors.affiliation: Section of Palliative Medicine and Hospice, Lehigh Valley Health Network, Allentown, Pennsylvania, USA.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Ray
authors.affiliation: Duffey Pain/Palliative Care Program, Johns Hopkins Kimmel Cancer Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: Sydney Morss
authors.initials: SM
authors.lastname: Dy
mesh_terms: D032722:Advance Care Planning; D002983:Clinical Competence; D003142:Communication; D003430:Cross-Sectional Studies; D054521:Cultural Competency; D004635:Emergency Medicine / Q000193:education* / Q000458:organization & administration; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D015999:Multivariate Analysis; D010166:Palliative Care; D010820:Physicians; D012044:Regression Analysis; D011795:Surveys and Questionnaires; D014481:United States
keywords: Medical education; emergency medicine; palliative care; residency training