Medical residents' perceptions of end-of-life care training in a large urban teaching hospital.

Abstract

Contemporary medicine has begun to reemphasize the importance of palliative and end-of-life-care. This shift requires a commensurate change in physician education to provide adequate palliative care training. The present research assessed medical residents' perceptions of their clinical and educational experiences in palliative care training as provided by a large urban teaching hospital. All graduating third-year residents in internal medicine, family medicine, and social pediatrics at Montefiore Medical Center were asked to participate in a brief telephone survey. The survey assessed residents' experiences in caring for patients who were dying or had died, and their evaluation of faculty supervision, clinical rotations, and academic activities. Fifty-five residents (90%) were surveyed. They reported caring for few patients at the end of life over their 3 years of training (median of 10 inpatients who died, one outpatient who died, and three outpatients who were potentially terminally ill). Furthermore, the majority of residents gave poor ratings to clinical supervision and to clinical rotations where they were likely to evaluate dying patients (intensive care units and oncology), with only 16% of residents reporting that they had received very good or outstanding palliative care training. In order to provide adequate palliative care education to future physicians, residency programs must strategically target hospital training units, enhance the quality of palliative care supervision and training that residents receive, and increase the number of dying patients they care for in ambulatory care and nonhospital settings. Recommendations for change are discussed.