Educating Medical Residents in End-of-Life Care: Insights from a Multicenter Survey

Schroder, Cori; Heyland, Daren K.; Jiang, Xuran; Rocker, Graeme; Dodek, Peter

doi:10.1089/jpm.2008.0280

Cited by 80 publications

(80 citation statements)

References 26 publications

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“…Trainees report inadequate knowledge and a lack of competence in PC skills and would like more training and education in palliative and end-of-life care. [15][16][17][18][19][20][21][22] At The University of Texas MD Anderson Cancer Center, the PC program was established in 1999, and PC is delivered in three different settings: five mobile consultation teams, an acute PC unit, and an outpatient supportive care clinic. 23 The fellows and trainees at MD Anderson come into frequent contact with PC during the process of direct patient care and also during rotations in PC.…”

Section: Resultsmentioning

confidence: 99%

“…Lack of training in PC may result in less use of the PC service, which may reflect on overall patient care and quality of care. Qualitative studies concluded that previous training in PC increases the competencies of trainees with end-of-life care 20,21 and general patient care. 41 Two thirds of the trainees surveyed agreed that mandatory rotations in PC should be implemented in medical schools and residency training programs.…”

Section: Discussionmentioning

confidence: 99%

“…12 Several studies that surveyed trainees have shown that training is inadequate but desired by trainees. [15][16][17][18][19][20][21][22] Currently, standardized curricula for undergraduate and graduate trainees are being developed. 42 One of the secondary outcomes of a randomized control trial of early PC access was that patients referred to PC experienced longer survival.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

ReCAP: Attitudes, Beliefs, and Awareness of Graduate Medical Education Trainees Regarding Palliative Care at a Comprehensive Cancer Center

Wong

Reddy

Williams

et al. 2016

JOP

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QUESTION ASKED: What are graduate medical education trainees' attitudes and beliefs regarding palliative care, what is their awareness of the availability and role of palliative care services, and does previous exposure to a palliative care rotation facilitate a better awareness of palliative care?SUMMARY ANSWER: A vast majority of oncology trainees perceived palliative care services to be beneficial for patient care (92%) and were supportive of mandatory palliative care training (74%). Surgical oncology trainees and trainees with no previous palliative care exposure were significantly less likely to consult palliative care and had significantly less awareness of palliative care. METHODS:We conducted an institutional review board-approved online survey to determine awareness of palliative care among graduate medical trainees at MD Anderson. One hundred seventy oncology trainees who completed at least 9 months of training in medical, surgical, gynecologic, and radiation oncology fellowship and residency program during the 2013 academic year completed an online questionnaire. Descriptive, univariate, and multivariate analyses were performed. BIAS, CONFOUNDING FACTOR(S), DRAWBACKS:Although there was a substantial response rate (78%), the results may not be generalizable as the survey was conducted at a single institution. Also, the frequency of palliative care referrals is self-reported. REAL-LIFE IMPLICATIONS:Our findings suggest that exposure to palliative care training may lead to increased awareness of palliative care among oncologists, and thus, increased overall and early referrals to palliative care. Surgical oncology trainees may benefit from increased exposure to palliative care rotations. More research is needed to characterize the impact of training on referral patterns to palliative care. In the meantime, efforts should be made to include formal palliative care rotations in oncology training. Participants and MethodsWe conducted a survey to determine awareness of PC among graduate medical trainees at a comprehensive cancer center with an established PC program. One hundred seventy oncology trainees who completed $ 9 months of training in medical, surgical, gynecologic, and radiation oncology fellowships and residency programs during the 2013 academic year completed an online questionnaire. Descriptive, univariable, and multivariable analyses were performed. ResultsThe response rate was 78% (132 of 170 trainees); 10 trainees without hands-on patient care were excluded.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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ReCAP: Attitudes, Beliefs, and Awareness of Graduate Medical Education Trainees Regarding Palliative Care at a Comprehensive Cancer Center

Wong

Reddy

Williams

et al. 2016

JOP

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“…A recent study shows that if the primary care physician remains involved, patient and family have less distress (5). Educational programs have been successful in teaching physicians, in training and in practice, important knowledge and communication skills used in palliative care (3,6,30,31,80,89), but much more needs to be done to deliver primary palliative care across the health care system. Variation exists with regard to physician willingness to refer patients to a secondary palliative care specialist or team (1,99).…”

Section: Barriers To Further Integration Of Palliative Carementioning

confidence: 99%

The Growth of Palliative Care in the United States

Hughes

Smith

2014

Annu. Rev. Public Health

207

146

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Palliative care has been one of the most rapidly growing fields of health care in the United States in the past decade. The benefits of palliative care have now been shown in multiple clinical trials, with increased patient and provider satisfaction, equal or better symptom control, more discernment of and honoring choices about place of death, fewer and less intensive hospital admissions in the last month of life, less anxiety and depression, less caregiver distress, and cost savings. The cost savings come from cost avoidance, or movement of a patient from a high cost setting to a lower cost setting. Barriers to expanded use include physician resistance, unrealistic expectations of patients and families, and lack of workforce. The future of palliative care includes more penetration into other fields such as nephrology, neurology, and surgery; further discernment of the most effective and cost-effective models; and establishment of more outpatient services.

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“…[19][20][21][22][23][24][25] The focus of other recent work that explicitly or implicitly mentioned educational transition has been on education in the ''business'' aspects of medicine 26 and leadership training for fellows. 27 Promising areas to prepare physicians for the transition into practice include enhanced preparation for providing culturally competent care; 28 end-of-life care, particularly for individuals in subspecialty training in pain medicine and critical care; 29 and the cost-effective use of medical resources. 30 Another focal area is monitored and mentored experiences in a clinical specialty at the completion of residency so as to ease the surgical/technical transition into practice.…”

Section: Transitions Across the Medical Education Continuummentioning

confidence: 99%

Review article: Closing the research gap at the interface of learning and clinical practice

Philibert

2011

Can J Anesth/J Can Anesth

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Purpose The dialogue at the interface of education and clinical practice highlights areas of critical importance to the development of new approaches for educating anesthesiologists. The purpose of this article is to examine the literature on education and acquisition of competence in three areas relevant to the interface of learning and clinical practice, with the aim to suggest a research agenda that adds to the evidence on preparing physicians for independent practice. The three areas are: 1) transitions across the continuum of education; 2) the effect of reductions in hours of clinical training on competence; and 3) efforts to incorporate the competencies and CanMEDS roles into teaching and evaluation. Principal findings Fifty-six articles relevant to one or more of the themes were identified in the review, including 21 studies of transitions (in, during, and after residency education), 19 studies on the effects of duty hour limits on residents' acquisition of competence, and 16 articles that assessed competency-based teaching and assessment in anesthesiology. Overall, the findings suggested a relative paucity of scientific evidence and a need for research and the development of new scientific theory. Studies generally treated one of the themes in isolation, while in actuality they interact to produce optimal as well as suboptimal learning situations, while medical education research often is limited by small samples, brief follow-up, and threats to validity. This suggests a ''research gap'' where editorials and commentaries have moved ahead of an evidence base for education. Promising areas for research include preparation for care deemed important by society, work to apply knowledge about the development of expertise in other disciplines to medicine, and ways to embed the competencies in teaching and evaluation more effectively. Conclusion Closing the research gap in medical education will require clear direction for future work. The starting point, at an institution or nationally, is dialogue within the specialty to achieve consensus on some of the most pressing questions.

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Educating Medical Residents in End-of-Life Care: Insights from a Multicenter Survey

Cited by 80 publications

References 26 publications

ReCAP: Attitudes, Beliefs, and Awareness of Graduate Medical Education Trainees Regarding Palliative Care at a Comprehensive Cancer Center

ReCAP: Attitudes, Beliefs, and Awareness of Graduate Medical Education Trainees Regarding Palliative Care at a Comprehensive Cancer Center

The Growth of Palliative Care in the United States

Review article: Closing the research gap at the interface of learning and clinical practice

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