Evidence of improved knowledge and skills after an elective rotation in a hospice and palliative care program for internal medicine residents

Abstract

There is compelling evidence that residents training in primary care need education in palliative care. Evidence for effective curricula is needed. The objective of this study was to test whether a clinical elective improves measures of knowledge and skill. Residents from three categorical training programs in internal medicine were recruited to an elective including clinical experiences in an acute hospital palliative care consultation service, on an acute hospice and palliative care unit, and in-home hospice care. A 25-question pre- and post-test and a videotaped interview with a standardized patient were used to assess communication skills and measure outcomes. Residents demonstrated a 10 percent improvement in knowledge after the four-week elective (p < 0.05). All residents demonstrated basic competency in communication skills at the end of the rotation. These results indicate that clinical rotation shows promise as an educational intervention to improve palliative care knowledge and skills in primary care residents. An important limitation of the study is that it is an elective; further studies with a required rotation and/or a control group are needed to confirm the findings.

Using a Pocket Card to Improve End-of-life Care on Internal Medicine Clinical Teaching Units: A Cluster-randomized Controlled Trial

“…Resident knowledge scores were approximately 60% overall on the pretest, which is comparable to previous studies in the literature. 10,13,21 The improvement in overall knowledge scores in the intervention group was statistically significant and consistent with the effect size seen in other studies. 10,18 Among individual test items, resident scores improved most notably in the dosage-based questions (i.e., dose frequency and dose equivalence).…”

“…Unlike previous studies that featured a lengthy, comprehensive education intervention or a dedicated palliative care rotation, 4,[9][10][11][12]18 our study evaluated a cheap, portable, and easily implemented educational tool. It could be used alone or added to an existing curriculum and may be easily updated with new information.…”

“…[3][4][5] Not surprisingly, many hospitalized patients spend their final days in significant pain. 6,7 Previous studies have shown that comprehensive educational interventions or dedicated palliative care rotations can influence trainees' comfort and proficiency in providing end-oflife care, 4,[8][9][10][11][12] but these may be difficult for many residency programs to implement. By contrast, small, portable teaching aids such as pocket cards are inexpensive and popular among medical students and residents on CTUs.…”

Resources for Educating, Training, and Mentoring All Physicians Providing Palliative Care

“…Several authors have shown that completing a palliative care rotation improves trainee comfort and skill in symptom management. 15,16 Others have shown that a one-to two-day workshop can improve knowledge and comfort with providing palliative care. 17 Some have demonstrated the effectiveness of integrating longitudinal palliative care curricula or distance learning into postgraduate medical education for improving comfort and knowledge among trainees.…”

Common myths about caring for patients with terminal illness: Opportunities to improve care in the hospital setting

“…8 -10 Efforts to improve the quality of end-of-life care have been diverse, including increased educational programs, [11][12][13] development of palliative care units in hospitals, 14,15 and greater exposure to palliative care for physicians during residency training. 16 Despite these efforts, studies assessing the attitudes and knowledge of physicians about hospice and palliative care continue to show deficits in knowledge about managing pain 17,18 as well as hospice policies and services.…”