Educating Internal Medicine Residents on Palliative Medicine and Hospice Care at a Community Teaching Hospital

Abstract

Background: The Accreditation Council of Graduate Medical Education (ACGME) currently requires Internal Medicine (IM) GME programs to incorporate educational opportunities for training and structured experiences in Palliative and Hospice Medicine. Miscomprehension of the differences between palliative medicine and hospice care is a barrier for IM residents ordering palliative consults as many residents may underutilize palliative medicine if a patient is not appropriate for hospice. Objective: This educational performance improvement (PI) project assessed 3 domains, including Medical Knowledge (MK) of palliative versus hospice medicine at baseline and following a single didactic session. Additionally, the number of palliative consults ordered was used as a surrogate for interpersonal and communication skills (ICS) and patient care (PC) domains. Methods: An 8-question survey and 30-minute didactic session were created based upon experientially-determined issues most confusing to IM residents. Participants included 33 IM residents (PGY-1s-3 s) from July 2018 (first cohort) and 32 (PGY-1 s and any PGY-2s-3 s who did not participate in the first cohort) from July 2019 (second cohort). Results: 65 of a possible 73 residents participated (89% response rate) Pre-test Questions 5, 6, and 8 correct responses were <50% in both cohorts with average scores, respectively, of 43.1%, 35.4%, and 40%. Residents improved on the post-test for Q5, 6, 8 to, respectively, 80%, 86.7%, and 48.3% (t = 7.68, df = 59, p < 001). Correct Q1 responses declined in the first cohort, but clarification for the second cohort improved from pre-test (36.4%) to post-test (65.5%). The total number of palliative consults placed by IM residents increased as well. Conclusions: Baseline MK of palliative versus hospice medicine was <50% on 4/8 questions. A brief educational session significantly improved residents’ short-term comprehension and increased the number of palliative consults.

Undergraduate palliative care education in the United Arab Emirates: a nationwide assessment of medical school deans

“…Further, several universities present these topics through workshops and didactics entitled "end-of-life care" and "death and dying. " Studies have shown that medical trainees do not understand the difference between PC and providing hospice or EOL care to terminal patients [16]. PC can be provided in conjunction with life-prolonging or curative modalities, and has been shown to improve the quality of life of patients with serious illness, regardless of whether or not that illness is terminal.…”

“…PC can be provided in conjunction with life-prolonging or curative modalities, and has been shown to improve the quality of life of patients with serious illness, regardless of whether or not that illness is terminal. As such, this confusion can become an impediment to the provision of PC services to non-terminal patients [16]. This also likely contributes to limited student awareness of PC as a distinct medical specialty.…”

Defining Key Elements of a Clinical Experience in Hospice and Palliative Medicine for Medical Residents in the United States

“…Medical residents may struggle to distinguish palliative from hospice care, 24 and we believe that a meaningful HPM clinical experience should highlight the key components of hospice. The term “hospice care” both refers to a philosophical approach to care and often carries connotations regarding where care will be delivered.…”