In Reply: We appreciate Dr. Tageja's thoughts regarding the limitations of our study. We agree that residents' perceptions of their own abilities to provide end-of-life care may not match their true competence. Our study measured residents' perceptions of their skills in providing end-of-life care; the relationship between residents' self-perceptions and actual skills is not clear. We also agree that social desirability bias and response bias could have affected our study's results. Further research to investigate the association between self-perceived and actual end-of-life care skills is under way. Our article reported the results of the initial intake survey of participants in a randomized trial comparing standard end-of-life care training with a communication skills-building course using standardized patients. As part of the study, patients with advanced diseases and their families that received care from the residents enrolled in the trial were surveyed to assess the residents' skills in providing end-of-life care. Preliminary data from our group suggest a positive but weak association between perceived and actual skills.1 Nonetheless, residents' perceptions of their skills may provide important information affecting their confidence and experiences in providing end-of-life care. Further research is needed to develop, evaluate, and implement programs that can improve physicians' skills at providing end-of-life care, both physicians in training and those in practice. Recent advances in the training for and delivery of palliative and end-of-life care make us optimistic that we are on the right track.2–4 Martha E. Billings, MD Health service research and development fellow, Department of Veterans Affairs, Puget Sound Health Care System, Division of Pulmonary Critical Care Medicine, University of Washington, Seattle, Washington; [email protected]. J. Randall Curtis, MD, MPH Professor of medicine, Division of Pulmonary Critical Care Medicine, University of Washington, Seattle, Washington. Ruth A. Engelberg, PhD Research associate professor, Division of Pulmonary Critical Care Medicine, University of Washington, Seattle, Washington.