title: Resident reflections on end-of-life education: a mixed-methods study of the 3 Wishes Project.
abstract: OBJECTIVE
  The objectives of this study were to describe residents' experiences with end-of-life (EOL) education during a rotation in the intensive care unit (ICU), and to understand the possible influence of the 3 Wishes Project.
  
  
  METHODS
  We enrolled dying patients, their families and 1-3 of their clinicians in the 3 Wishes Project, eliciting and honouring a set of 3 wishes to bring peace to the final days of a critically ill patient's life, and ease the grieving process for families. We conducted semistructured interviews with 33 residents who had cared for 50 dying patients to understand their experiences with the project. Interviews were recorded, transcribed verbatim, then analysed using a qualitative descriptive approach.
  
  
  METHODS
  21-bed medical surgical ICU in a tertiary care, university-affiliated hospital.
  
  
  RESULTS
  33 residents participated from internal medicine (24, 72.7%), anaesthesia (8, 24.2%) and laboratory medicine (1, 3.0%) programmes in postgraduate years 1-3. 3 categories and associated themes emerged. (1) EOL care is a challenging component of training in that (a) death in the ICU can invoke helplessness, (b) EOL education is inadequate, (c) personal connections with dying patients is difficult in the ICU and (d) EOL skills are valued by residents. (2) The project reframes the dying process for residents by (a) humanising this aspect of practice, (b) identifying that family engagement is central to the dying process, (c) increasing emotional responsiveness and (d) showing that care shifts, not stops. (3) The project offers experiential education by (a) intentional role modelling, (b) facilitating EOL dialogue, (c) empowering residents to care in a tangible way and (d) encouraging reflection.
  
  
  CONCLUSIONS
  For residents, the 3 Wishes Project integrated many forms of active learning for residents. Practice-based rather than classroom-based programmes may engage trainees to develop EOL skills transferable to other settings.
authors.affiliation: Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada Department of Critical Care, McMaster University, Hamilton, Ontario, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Centofanti
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Swinton
authors.affiliation: Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Dionne
authors.affiliation: Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Barefah
authors.affiliation: Department of Medicine, McMaster University, Hamilton, Ontario, Canada Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada Department of Medicine and Critical Care, St. Joseph's Healthcare, Hamilton, Ontario, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Boyle
authors.affiliation: Department of Medicine, McMaster University, Hamilton, Ontario, Canada Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada Department of Medicine and Critical Care, St. Joseph's Healthcare, Hamilton, Ontario, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Woods
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Shears
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: D
authors.initials: D
authors.lastname: Heels-Ansdell
authors.affiliation: Department of Critical Care, McMaster University, Hamilton, Ontario, Canada Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada Department of Medicine, McMaster University, Hamilton, Ontario, Canada Department of Medicine and Critical Care, St. Joseph's Healthcare, Hamilton, Ontario, Canada.
authors.forename: D
authors.initials: D
authors.lastname: Cook
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D007388:Internal Medicine; D007396:Internship and Residency; D007407:Interviews as Topic; D007755:Laboratories, Hospital; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000523:psychology*; D013727:Terminal Care / Q000592:standards*; D062606:Tertiary Care Centers; D055815:Young Adult
keywords: MEDICAL ETHICS