Development of a list of competencies and entrustable professional activities for resident physicians during death pronouncement: a modified Delphi study

Takaomi Kessoku,Kiyofumi Oya,Masanori Mori,Akihiko Kusakabe,Mitsunori Miyashita,Yasushi Ichikawa,Noritoshi Kobayashi,Tatsuya Morita,Atsushi Nakajima,Yu Uneno,Yuka Urushibara-Miyachi,Manabu Muto

doi:10.1186/s12909-022-03149-5

Abstract

BackgroundThe appropriate delivery of death pronouncements potentially affects bereaved families’ wellbeing positively. Although younger physicians need to learn the competencies and entrustable professional activities (EPAs) to conduct death pronouncement independently, both of which have not been clarified. Therefore, this study aimed to develop a list of competencies and EPAs necessary for death pronouncement practice, which resident physicians need to acquire by the end of their residency training (postgraduate year 2).MethodsAn anonymous modified Delphi study was conducted with a panel of 31 experts. The experts were invited online from general wards in hospitals with resident physicians across Japan to participate in the study using the purposive and snowball sampling method. A non-anonymous web conference was held with three additional external evaluators to finalize the item list. The consensus criterion was defined as a mean response of at least 4 points on a 5-point Likert scale for each competency and EPA item and a rating of 4 or 5 points by at least 80% of the participants.ResultsConsensus was achieved, with consistently high levels of agreement across panel members, on 11 competencies and 9 EPA items. Additionally, a correspondence matrix table between competencies and EPAs was developed.ConclusionsThis study clarified the standardized educational outcomes as competencies in death pronouncement practice and the unit of professional practice of physicians who can perform this independently (EPAs), serving as a blueprint to aid the development of an educational model and evaluation method for clinical educational institutions and developers of medical school curriculums.

Highlights

The appropriate delivery of death pronouncements potentially affects bereaved families’ wellbeing positively
The aim of this study is to develop a list of the competencies and entrustable professional activities (EPAs) of physicians’ behaviors in death pronouncement practice, which resident physicians need to acquire by the time of completion of their residency training
Since we considered that nurses play an essential role in bereavement care, before and after the delivery of the death pronouncement, and since they are considered to be essential members of multidisciplinary care teams, we included them in the Delphi survey

Summary

Introduction

The appropriate delivery of death pronouncements potentially affects bereaved families’ wellbeing positively. Physician-patient-family communication through the death pronouncement practice is critically important, as it potentially affects the families’ emotional and psychological wellbeing either positively or negatively (e.g., Kessoku et al BMC Medical Education (2022) 22:119 acute grief and long-term depression) [4]. This is because the death of a loved one is a critically serious life event for the family members and relatives of the deceased [4, 5]. These studies have shown that compassionate and calm behavior throughout the practice is universally important regardless of the specific cultural context [7,8,9,10,11,12,13,14,15]

Objectives

Methods

Results

Discussion

Conclusion