Internal Medicine Residents Perceptions of Death and Dying: What Do We Know? (751)

Abstract

Objectives 1. Discuss the feasibility of introducing end-oflife care communications to graduating medical students. 2. Identify methods for incorporating standardized patient encounters into teaching of sensitive EOL care communications. I. Background. Interns and residents often report feeling unprepared to conduct sensitive end-oflife (EOL) communications. We piloted an experiential program designed to instruct graduating medical students on death assessment, death notification, and running a goals of care family meeting. II. Research Objectives. 1. Determine feasibility of a palliative care course for graduating medical students. 2. Assess the realism of SP encounters teaching palliative care communications. III. Methods. The structured educational experience included three hours of training in a small group setting. Power-point presentations and readings were provided prior to the encounter. Standardized patient encounters (SPE) were conducted for all these communications. Students were separated into groups of 2 or 3; one leading the encounter that was followed by an unstructured faculty directed 360 evaluation. Students reported on previous clinical exposure to similar scenarios, emotional self-perceptions, and knowledge via written and verbal feedback. IV. Results. Seventeen fourth-year medical students completed the experience. While all students reported prior exposure to a goal-of-care discussion, each reported this SPE scenario hardest to complete and important in improving communication skills. Fourteen percent of students had prior exposure to a death notification and 0% had witnessed a death pronouncement. All the students reported the pronouncement/ notification scenarios to be realistic and helpful. Students reported positive themes of self-awareness, acknowledgement of discomfort, and experiencing emotions of humanity. Themes for improvement included shortening the cases and providing a formal lecture prior to encounters. Students overwhelmingly believed all scenarios improved readiness to begin internship and provided a platform to engage in palliative care conversations. V. Conclusion. A palliative care intensive course for graduating medical students is feasible and perceived as valuable in preparing for internship. VI. Implications for Research, Policy, or Practice. Development of innovative programs to better prepare medical students for communicating on common EOL scenarios. Evaluating student performances in these scenarios beginning and end of graduating year.