title: Primary Care Residents Improve Knowledge, Skills, Attitudes, and Practice After a Clinical Curriculum With a Hospice.
abstract: Effective approaches to teaching attitudes, knowledge, and skills to resident physicians in primary care that can be implemented in any residency program are needed. We examined the feasibility and impact of a single palliative care residency curriculum, including a clinical rotation with a hospice program, across 5 cohorts of residents in 7 divergent primary care residency programs (both family medicine and internal medicine). The didactic content was drawn from the national Education for Physicians on End-of-Life Care Project. A total of 448 residents completed the curriculum. A large effect size was seen in measures of knowledge change (*Cohen d = .89) when compared to a national sample of primary care residency programs. Additionally, measures of confidence to perform palliative care skills and ethical concerns also improved significantly ( P < .001). A frequent comment is wishing the rest of medicine were like that experienced in the hospice setting. In a separate, ancillary evaluation, the average length of stay of patients enrolled in hospice care was 18.5 days longer for the alumni of this program when compared to physicians referring for hospice care who hadn't experienced the curriculum.
authors.affiliation: 1 Kobacker House, OhioHealth, Columbus, OH, USA.
authors.forename: Charles F
authors.initials: CF
authors.lastname: von Gunten
authors.affiliation: 2 Department of Medical Education, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Patricia B
authors.initials: PB
authors.lastname: Mullan
authors.affiliation: 3 Independent Reseacher, San Diego, CA, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Nelesen
authors.affiliation: 4 Institute for Palliative Care, California State University-San Marcos, San Marcos, CA, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Garman
authors.affiliation: 5 Healthcare Education, Leadership, and Performance Inc, San Diego, CA, USA.
authors.forename: Helen
authors.initials: H
authors.lastname: McNeal
authors.affiliation: 6 School of Medicine, University of California, San Diego School of Medicine, San Diego, CA, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Savoia
authors.affiliation: 6 School of Medicine, University of California, San Diego School of Medicine, San Diego, CA, USA.
authors.forename: Elaine
authors.initials: E
authors.lastname: Muchmore
authors.affiliation: 6 School of Medicine, University of California, San Diego School of Medicine, San Diego, CA, USA.
authors.forename: Tyson
authors.initials: T
authors.lastname: Ikeda
authors.affiliation: 7 Department of Internal Medicine, Scripps Mercy Hospital, San Diego, CA, USA.
authors.forename: Stan
authors.initials: S
authors.lastname: Amundson
authors.affiliation: 7 Department of Internal Medicine, Scripps Mercy Hospital, San Diego, CA, USA.
authors.forename: Marianne
authors.initials: M
authors.lastname: McKennett
authors.affiliation: 8 Department of Internal Medicine, Scripps Green Hospital, San Diego, CA, USA.
authors.forename: Joel
authors.initials: J
authors.lastname: Diamant
authors.affiliation: 9 Department of Internal Medicine, U.S. Naval Hospital, San Diego, CA, USA.
authors.forename: Patricia
authors.initials: P
authors.lastname: Pepper
authors.affiliation: 10 Department of Family Medicine, U.S. Naval Hospital, Camp Pendleton, CA, USA.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Gray
authors.affiliation: 11 Department of Palliative Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: David
authors.initials: D
authors.lastname: Weissman
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003142:Communication; D003479:Curriculum; D005194:Family Practice / Q000193:education*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D017051:Hospice Care / Q000379:methods / Q000458:organization & administration*; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency / Q000458:organization & administration*; D008297:Male; D059408:Pain Management / Q000379:methods; D010166:Palliative Care / Q000379:methods / Q000458:organization & administration; D010347:Patient Care Planning
keywords: education; hospice; pain; palliative medicine; personal reflection; resident