Prospective evaluation of surgical palliative care immersion training for general surgery residents

Abstract

BackgroundPalliative care competencies in surgical training are recognized to improve the care of surgical patients with advanced or life-threatening illnesses. Formal programs to teach these competencies are lacking. The study aims to assess the feasibility and utility of a unique surgical palliative care immersion training program. Study designA half-day Surgical Palliative Care Immersion Training (SPCIT) was developed using the American College of Surgeon's manual titled “Surgical Palliative Care: A Resident's Guide” as a framework. The training format was modeled after the highly successful University of Arizona Center on Aging's Interprofessional Chief Resident Immersion Training (IP-CRIT) Program to teach palliative care competencies to general surgery residents. Objective and self-assessments were performed at baseline, immediately post training and 5-months after training. For all pre-test, post-test comparisons on Likert scale, Wilcoxon Signed Rank Test was used. For aggregate scores a repeated-measures analysis of variance was used. ResultsForty of the forty-eight residents (83%) completed the learner's needs assessment survey. Thirty-four (71%) of the forty-eight residents in the residency program participated in the SPCIT. Significant improvement was noted in objective assessment of post-test aggregate scores (Mean difference 2.15, 95% CI 0.52–3.77, p = 0.0083). There was a significant increase in proportion of residents who felt confident in discussing palliative care options (96.5% vs. 27.5%, p < 0.0001); end-of-life care (86.2% vs. 52.5%, p < 0.0065); code status (86% vs. 15%, p < 0.0001); prognosis (96% vs. 35%, p < 0.001); or withholding or withdrawing life support (79.2% vs. 45%, p = 0.0059) with patient/families after the SPCIT. ConclusionThe newly developed SPCIT program drastically improves knowledge, attitudes and perceived skills of general surgery residents. Similar training can be implemented in other surgical residency programs.