Reality Bytes: Teaching Evidence-Based Medicine on a Palliative Medicine Service

Abstract

that IM core curricula include end-of-life care and pain management concepts. Additionally, fellows in hematology/oncology, pulmonary/ critical care, and geriatrics should receive formal instruction and clinical experience in palliative and end-of-life care. II. Research Objectives. We aimed to assess the effectiveness of current teaching methods for residents and fellows at four university-affiliated training sites. III. Methods. We conducted online surveys of IM residents and fellows in geriatrics, hematology/ oncology, and pulmonary/critical care on seven domains of knowledge of palliative care and pain management and self assessment of competence in these areas. We also assessed trainees’ current exposure and types of palliative care education, as well as their preferred method of learning. Surveys were conducted in the beginning and end of the academic year (the ‘‘end’’ of year study is underway). IV. Results. On the initial survey, we received 180 (55%) of 326 email surveys: 143 by residents and 37 by fellows. All sites were represented in the responses. Less than 50% of IM residents understood proper opioid dosing and non-pain symptom evaluation. A total of 70% or less of fellows correctly answered questions on opioid dosing, delirium, and non-pain symptom evaluation. This was true even among those who felt their competence was high. The majority of trainees reported ‘‘no’’ or ‘‘too little’’ educational training in the prior academic year. Over 70% felt lectures would be useful or very useful. Only 3.1% felt a dedicated palliative medicine rotation would not be useful. V. Conclusion. This data reveals that self assessment of knowledge did not always match actual knowledge base. Fellows did not always have better knowledge than residents. Major areas such as pain management and other end-of-life symptoms are poorly understood by most trainees. VI. Implications for Research, Policy, or Practice. A more focused curriculum in palliative and endof-life care is needed for residents and fellows.