PURPOSE: Addressing end-of-life care (EOLC) is an important aspect of intensive care medicine. Despite the need for better EOLC, there is little formal training in residency and medical school. Our objective was to assess the effects of targeted training in EOLC on performance and comfort in first-year internal medicine residents.
METHODS: All first-year residents were surveyed at the beginning and end of internship to assess comfort level, training and experience in medical school with “do not resuscitate” (DNR) orders, palliative care and hospice, discussing patient prognosis and withdrawal of life sustaining medical treatment (WLSMT). All residents attended a lecture series geared towards EOLC and discussing patient prognosis. Half of the residents completed two different standardized scenarios and were graded by observers on their ability to communicate EOLC issues based on completing ten communication tasks. Their performance was rated on three different scales (eight questions on Humanism 0-100, ten questions on Saintliness 0-100, overall score Osler 0-1000). The Humanism score was described by Hauck, Saintliness and Osler scores were developed at our institution.
RESULTS: Fourteen residents completed both surveys. Our resident population was multi-cultural and diverse (8 different ethnicities, 9 languages spoken other than English, 5 foreign born, males and females equal distribution). Most reported low comfort levels and no training or involvement in EOLC prior to residency. Post intervention, residents reported more comfort with discussing DNR, hospice, and delivering bad news, but were still uncomfortable with WLSMT and administering palliative pain medications. Simulated patient exercises showed improvement in ability to communicate bad news (average 17.97 points, p=0.032). Humanism and Saintliness scores also improved (10.49 p= 0.019, and 10.52 p=0.023 respectively). The Osler score improved by 103.65 (p=0.008). Those that improved the most were residents who initially scored the lowest.
CONCLUSIONS: We confirmed that first-year multi-cultural residents had insufficient training in EOLC prior to residency and were uncomfortable discussing EOLC. Targeted training and education improved residents comfort and performance in EOLC.
CLINICAL IMPLICATIONS: Improvements in EOLC training are necessary and acheivable.
DISCLOSURE: The following authors have nothing to disclose: Naleena Sidhu, Beata Chauhan, Kristin Fless, Fariborz Rezai, Paul Yodice
No Product/Research Disclosure Information