Primary Care Residents Improve Knowledge, Skills, Attitudes, and Practice After a Clinical Curriculum With a Hospice

Abstract

Effective approaches to teaching attitudes, knowledge, and skills to resident physicians in primary care that can be implemented in any residency program are needed. We examined the feasibility and impact of a single palliative care residency curriculum, including a clinical rotation with a hospice program, across 5 cohorts of residents in 7 divergent primary care residency programs (both family medicine and internal medicine). The didactic content was drawn from the national Education for Physicians on End-of-Life Care Project. A total of 448 residents completed the curriculum. A large effect size was seen in measures of knowledge change (*Cohen d = .89) when compared to a national sample of primary care residency programs. Additionally, measures of confidence to perform palliative care skills and ethical concerns also improved significantly ( P < .001). A frequent comment is wishing the rest of medicine were like that experienced in the hospice setting. In a separate, ancillary evaluation, the average length of stay of patients enrolled in hospice care was 18.5 days longer for the alumni of this program when compared to physicians referring for hospice care who hadn't experienced the curriculum.

A Systematic Review of Training in Symptom Management in Palliative Care Within Postgraduate Medical Curriculums

“…From the literature, cohort studies exploring the transference of knowledge on symptom management and skills into the workplace are equivocal. 62,67 A few studies have evaluated the sustainability of improvements in physicians' practices or patient outcomes after a pain or non-pain…”

Impact and Reception of a Required 4-Week Palliative Medicine Rotation

“…A 4-week hospice rotation improved resident confidence regarding palliative skills, and a 2-week required rotation showed improved communication skills. 8,9 A significant improvement in knowledge, attitudes, and skills was measured after residents completed a 4-week hospice rotation, and 50% of the residents surveyed perceived that the content was not available elsewhere in their training. 10 Another study found a significant improvement in all palliative care domains after residents completed a geriatrics rotation with palliative education built into the curriculum.…”

How to ensure basic competencies in end of life care – a mixed methods study with post-graduate trainees in primary care in Germany

“…Internationally, there is a lack of literature on the education of competencies in EoLC in both postgraduate trainees and especially in GP trainees: There are few published curricula such as from 2016 [37] and the questions of how and how much of teaching of EoLC is necessary during specialisation in general practice. If for example communicational skills in EoLC should be trained or if an intense course on EoLC is developed a well-planned curriculum based on previous experiences is mandatory [38,39]. A recent study, which was not available in 2016 when we had planned our study, presented a list of necessary learning objectives and goals for EoLC [40].…”