Impact of palliative care rotation on gynecologic oncology fellows' knowledge, rates of explicit teaching, and perceived competence in palliative care.

Abstract

95 Background: Impact of a PC rotation on fellows in the primarily surgical specialty of Gynecologic Oncology (GO) has not been described. We aimed to evaluate the impact of a month-long PC rotation on GO fellows’ knowledge, exposure to explicit teaching and perceived competence in PC. Methods: Four years of GO fellows (n = 8) were surveyed before and immediately after a month-long PC rotation about knowledge, explicit teaching and perceived competence across four domains - pain management, non-pain symptom management, out of hospital care and communication/ethics. Knowledge was assessed via 30 multiple choice questions (MCQ). Perceived competence to address 25 PC topics was assessed on a Likert scale (1 to 5). Participants were asked about explicit teaching of 21 PC topics before and during the rotation. The rotation included 5 clinical settings and 7 dedicated didactic strategies beyond routine participation in clinical care. We used medians tests to compare total correct items pre vs post rotation, paired differences pre to post of perceived competence and paired differences pre to during rotation rates of explicit teaching of PC topics. Results: Post-rotation, participants demonstrated significant improvement in knowledge (median MCQ percent correct pre 62% v post 67%; p = 0.01), explicit teaching (median percent items explicitly taught pre 19% v post 91%; p = 0.02) and perceived competence (median percent items competent or better pre 34% v post 100%; p = 0.01). The most highly rated clinical settings were inpatient hospice and inpatient PC consult service. The most highly rated didactic strategies were direct observation of communication skills practice and 10 minute didactics. The educational value of the overall rotation was rated as superior by 100% of participants. Conclusions: After a month-long PC rotation, GO fellows demonstrated significant improvement in knowledge, rates of explicit teaching and perceived competence in PC across all domains examined. Routine incorporation of a dedicated PC rotation should be considered for all gynecologic oncology fellows.