Helping Patients Die: Implementation of a Residency Curriculum in Medical Aid in Dying.

Abstract

As more states legalize medical aid in dying (MAID), there is an ever-increasing need of physicians trained in this type of end-of-life care. However, resident curricula in MAID have not been previously reported or assessed. The authors describe a residency curriculum in MAID and evaluate the resident outcomes of this program. Since 2018, the Sutter Family Medicine Residency Program in California has offered training in MAID to its residents. Residents attend lectures, evaluate patients for MAID, write prescriptions for aid-in-dying medications, and attend the planned deaths of their patients if desired. In February 2023, an anonymous branching survey was sent to graduates of the program from 2019 to 2022 to evaluate residency graduation year, receipt of MAID training, currently practicing MAID, how rewarding MAID is compared with other clinical responsibilities, how stressful MAID is compared with other clinical responsibilities, comfort discussing MAID with colleagues, comfort discussing end-of-life care generally, personal view of MAID as a practice, and works where MAID is permitted. The authors surveyed 28 graduates and collected data from 21 former residents (response rate, 75%). Of these 21 former residents, 17 (81%) reported having opted to receive training in MAID during residency. Of the 12 residents who received training and were currently practicing in a location that allowed MAID, 7 (58%) were still practicing aid in dying, and of these 7 residents, 5 (71%) reported that their aid-in-dying work was more rewarding than their other clinical responsibilities. Overall, there was high resident interest in this training and robust skill use after graduation. Additional studies will need to focus on patient outcomes, explore resident reasons for opting out of training, and investigate other effects of instituting a MAID curriculum.