Palliative care education in surgery

Abstract

Though incorporating palliative care principles with standard medical and surgical care has been associated with multiple benefits, surgical training devotes far less time to developing skills within the palliative care domains. In this review, we sought to explore the existing literature concerning palliative care education within the context of surgical training. Current studies may be categorized under two major areas:(I) measurement of trainee exposure through needs assessments and (II) implementation of novel palliative care-based training curricula. Within the former group, a number of studies found surgical trainees having substantial exposure to seriously-ill and dying patients, yet the application of palliative care approaches was informed by informal, on-the-job experiences. Further, a number of studies found that a minority of trainees had previously been involved in some type of formalized palliative care training, and among those who did, the majority reported the quality of this training to be inferior relative to the quality of training of clinical or technical skills. Among the latter group of studies examining palliative care training curricula, multiple studies demonstrated that trainees improved significantly post-intervention with respect to palliative care skills, knowledge, attitudes, and comfort. In addition, trainees regarded palliative care skills as important for surgeons, and supported adoption of palliative care curricula within surgical training. Finally, though multiple palliative care resources currently exist for practicing surgeons and surgical trainees, most of these opportunities are optional and must be sought out by the individual surgeon. Consequently, in an effort to standardize palliative care in conjunction with surgical care, widespread adoption of palliative care curricula during residency training may prove to be most beneficial.

The State of Palliative Care Education in United States Physical Medicine and Rehabilitation Residency Programs

“…There is increasing recognition across medical and surgical specialties, including PM&R, of the need for and value of PC education for resident trainees. 8,9,[18][19][20][21][22][23][24] In neurology, recommendations for enhancing primary PC education for residents have recently been set forth, which include using patient simulations to practice advanced communication skills and structuring opportunities to debrief after challenging clinical scenarios. 18 Given overlapping neurology/PM&R populations, such recommendations may be valuable to consider in PM&R as well.…”

Palliative care in a rural surgery residency program: an educational needs assessment

“…As Ballou and Brasel remark, the Accreditation Council for Graduate Medical Education (ACGME) dictates a minimum number of a variety of procedures that general surgery residents must complete, yet there is no requirement for palliative procedures or palliative conversations (12). A recent review on palliative care education in surgery found that out of several studies assessing palliative care education in surgical trainees, most trainees lacked any formal training in palliative care (13). The few trainees who did have formal training found the quality of the training to be inferior to their training in clinical or technical skills (13).…”

“…A recent review on palliative care education in surgery found that out of several studies assessing palliative care education in surgical trainees, most trainees lacked any formal training in palliative care (13). The few trainees who did have formal training found the quality of the training to be inferior to their training in clinical or technical skills (13).…”

Would you be surprised? Prospective multicenter study of the Surprise Question as a screening tool to predict mortality in trauma patients

“…Palliative care interventions, delivered by either the primary team or a specialty PC team, lead to decreased hospital length of stay (LOS), [2][3][4] decreased intensive care unit (ICU) LOS, 2,3 earlier withdrawal of life-sustaining treatments, 2,5 decreased likelihood of invasive treatments, 5 better symptom management, 2,3,5 and increased goal-concordant care. 2,4 Surgeons face numerous barriers when attempting to integrate PC into their practices, including a lack of both formal and informal PC training, [6][7][8][9] lack of mentorship from surgical colleagues formally trained or well versed in PC, 7,9 time constraints, 7,9 and a surgical culture, although changing, which still often prioritizes lifesaving procedures above all else. 8 The lack of reliable prognostication tools for the multi-injured trauma patient remains a major challenge for clinicians as they attempt to provide prognostic information to patients and families.…”

“…Surgeons face numerous barriers when attempting to integrate PC into their practices, including a lack of both formal and informal PC training, 6–9 lack of mentorship from surgical colleagues formally trained or well versed in PC, 7,9 time constraints, 7,9 and a surgical culture, although changing, which still often prioritizes lifesaving procedures above all else 8 . The lack of reliable prognostication tools for the multi-injured trauma patient remains a major challenge for clinicians as they attempt to provide prognostic information to patients and families.…”