Critically ill patients and end-of-life decision-making: the senior medical resident experience

Abstract

In order to improve the understanding of educational needs among residents caring for the critically ill, narrative accounts of 19 senior physician trainees participating in level of care decision-making were analyzed. In this multicentre qualitative study involving 9 university centers in Canada, in-depth interviews were conducted in either English or French, and the transcripts then underwent a hermeneutic phenomenological analysis. The resident was the central figure in the narrated incident, along with the patients' relatives and other attending physicians. The vast majority of interviews recounted negative experiences that involved delivering bad news to patients' families and managing difficult communications with them and with physician colleagues. Emotional distress and suffering were often part of their decision-making process. Narrating their experiences was viewed as a positive event. Data analysis uncovered 6 general themes that were organized into 2 categories, the first one grouping together themes related to interactions with the patients' families and the second comprising themes related to interactions with physician coworkers. The findings suggest that physician trainees' narratives are a rich source of data regarding what constitutes meaningful training experiences and what they learn from them. Educational approaches that incorporate the telling of stories would allow students to express their feelings, doubts, and opinions about their work experiences and could thus foster personal and emotional learning in critical care.

Goals of care conversation teaching in residency – a cross-sectional survey of postgraduate program directors

“…Residents may also approach goals of care conversations in a scripted manner, with elements of the discussion and decision often misunderstood, and discrepancies between patients’ actual wishes and those documented [17, 18]. Residents perceive these conversations as difficult, often lack confidence in their own communication skills, and experience emotional distress [19, 20]. Assessment of residents’ perceptions and skills in having goals of care conversations will be important to verify or challenge program director perceptions within our local context.…”

Resident involvement in postoperative conversations: an underused opportunity

“…Interestingly, most of the residents in their study reported they received little to no faculty feedback on communication, whereas faculty felt they provided feedback. Studies from other medical disciplines report that residents felt that they would benefit from more education regarding communication, specifically breaking bad news, and feedback regarding communication skills [3–6]. …”

Le don de cornée : l’expérience des médecins résidents juniors et l’évaluation préliminaire de leurs besoins de formation

“…Comme le mentionnent Good et DelVecchioGood, le détachement fait parti des apprentissages des futurs médecins et les craintes notées en l'occurrence sont probablement celles de novices [21] . En revanche, les émotions font parties du processus décisionnel et, comme elles sont hautement imprévisibles, il pourrait s'avérerfortutiled'apprendreauxétudiantsenmédecine à les gérer, et ce tout au long de leur formation médi-cale [22,23] .…”

“…C'est donc la souffrance projetée des participants qui pèse énormément dans leur processus décisionnel. On sait par ailleurs que cet aspect de la communication est rarement abordé en cours de formation [23,24] . De fait, les participants jugent leur formation en matière de DC actuellement insuffisante et se sentent mal outillés pour y faire face dans la pratique.…”