title: On the ground floor looking up-Managing trainees' uncertainty at the end of life.
abstract: Recent US healthcare policy changes set the stage for integrating palliative and end-of-life care into routine medicine. However, these changes may not affect the daily practice of medical trainees-fellows, residents, and medical students-who as front-line care providers are not always equipped with the skills needed to treat terminally ill patients. We review evidence on trainees' discomfort with end-of-life care and highlight limitations of recent policy changes. Key barriers to proficiency include inadequate conversational training, prognostic uncertainty, and unfamiliarity with hospice and palliative care. Educator-, accreditor-, and policy-level interventions may improve trainees' experience caring for seriously ill patients.
authors.affiliation: Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Harvard Medical School, Boston, MA, USA. Electronic address: rbparikh@partners.org.
authors.forename: Ravi B
authors.initials: RB
authors.lastname: Parikh
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
authors.forename: Dhruv
authors.initials: D
authors.lastname: Khullar
mesh_terms: D003142:Communication; D004503:Education, Medical, Graduate / Q000379:methods / Q000592:standards; D006801:Humans; D007396:Internship and Residency / Q000379:methods; D011369:Professional-Patient Relations; D013337:Students, Medical / Q000523:psychology*; D013727:Terminal Care / Q000379:methods / Q000523:psychology* / Q000639:trends; D035501:Uncertainty; D000078329:Workforce