Primary Palliative Care Education for Internal Medicine Residents—A Needs Assessment (FR421A)

Abstract

•Describe knowledge and attitudes of Internal Medicine residents regarding primary palliative care.•Generate ideas about which topics to include in a resident Palliative Care curriculum. An aging patient population and increasing burden of serious illness have contributed to the expansion of Palliative Care (PC) programs in U.S. hospitals. Nevertheless, it has become clear that specialist delivery of PC will not meet the needs of this patient population. All providers need foundational skills in primary PC. Internal Medicine (IM) residency is an opportunity to shape PC education for providers who will practice across multiple subspecialties. We conducted a survey of knowledge and attitudes regarding primary PC among IM residents in order to develop a curriculum that will address their educational needs. We sent an anonymous survey to IM residents at an academic medical center. It prompted residents to evaluate the importance of primary PC and comfort with PC interventions. Surveys were completed by 24 PGY1s (42%) and 32 PGY2s and PGY3s (56%). When asked about the overall importance of PC, 93% reported it was “very important or important.” 75% could not define primary PC. More than 50% were not “satisfied” with their PC education. The following topics were “very important or important” for more than 75% of residents: breaking bad news, code status, pain management, other symptom management and prognostication. Less than 50% of residents felt “knowledgeable” in pain management, other symptom management and prognostication. MOLST and HCP forms were completed “never or rarely” by 85% and 56% of residents, respectively. Our survey highlights that, although IM residents value PC, they feel inadequately trained. Next steps include curricular improvement with new didactics, OSCEs and clinical supervision. We will repeat the survey after implementation of these changes to reassess resident competencies. We will use metrics, such as completion of Advanced Care Planning notes and change in ESAS scores, to evaluate how residents care for seriously ill patients. Our goal is for IM residencies to effectively train the next generation of primary PC providers.