How to Meet the New 2019 ACGME Requirements to Incorporate Palliative and Hospice Medicine into a Teaching Community Hospital's IM GME Residency Program (QI635)

Abstract

•Implement a simple eight-question novel survey tool to capture the baseline of medical knowledge the differences between palliative and hospice medicine.•Implement the novel 30-minute didactic session (12 PowerPoint slides) to improve comprehension of IM residents on the differences between palliative and hospice care.•Establish an anonymous tracking system for each resident to assess baseline medical knowledge of palliative and hospice medicine. As of July 2019, the Accreditation Council of Graduate Medical Education (ACGME) requires IM GME programs to incorporate training in palliative and hospice medicine. Miscomprehension of the difference between palliative medicine and hospice is a barrier for IM residents' ordering appropriate PM consults for patients with chronic, nonmalignant disease. Describe a novel survey to assess baseline medical knowledge (MK) of the differences between palliative and hospice medicine in IM trainees. Improve comprehension of these important differences after participation in a newly designed didactic session. We designed an eight-question survey to assess/ track our IM residents' comprehension of the differences and similarities of PM vs. hospice (Table 1). The survey and 30-minute didactic session were created based upon experientially determined issues that were most confusing to trainees (Supplement 1). The first cohort of 33 was from the AY 2018–2019 (PGY1s, 2s, and 3s). The second cohort was 32 PGY1s who began July 2019. Pretest questions 1, 5, 6, and 8 correct responses were < 50%, with average scores of 36.4%, 43.1%, 35.4%, and 40% respectively in both cohorts. A paired sample t-test found residents improved on the posttest for Q5,6,8 to, respectively, % correct of 73.8, 80, and 44.6 (t=7.68, df=59, p<.001) (figure 1). In the first cohort, the correct Q1 inexplicably declined from pre-to posttest, and verbal clarification for the second cohort increased Q1 response from pre- (36.4%) to post- (65.5%) (figure 2). Preintervention knowledge of the differences between PM and hospice medicine was < 50% on 4/8 questions. Our educational intervention significantly improved residents' short-term comprehension. Each cohort is reassessed in 1 year. Performance, by measuring the appropriateness of PM consultations for those patients with nonmalignant chronic illness, will be tracked and correlations with the comprehension assessment determined.